Introduction/Background The treatment of vulvovaginal cancer sometimes requires the excision of large areas of tissue that generate complex defects, with functional and aesthetic repercussions, both on the patients‘ quality of life and on their body image.

Small defects can be repaired with direct closure, but those caused by large, extensive surgeries will require reconstruction using other intervening tissues.

Methodology We present a video that includes a selection of neoplastic cases with the use of vulvovaginal reconstructive techniques:

• Simple vulvectomy, radical vulvectomy with V-Y advancement flaps

• Perineal resection and extended anterior pelvic exenteration with VRAM (rectus abdominis muscle) flap

• Extended perineal resection and pelvic exenteration

• Right hemicolpectomy with Gracilis muscle flap with skin graft

• Resection of the posterior wall of the vagina with the fasciocutaneous Malaga flap

• Vaginal stenosis (unilateral Malaga flap)

• Partial reconstruction of the vagina and perineum (Malaga flap and V-Y advancement flaps)

• Complete vaginal reconstruction (Malaga flaps and V-Y advancement flap).

Results Principles of reconstructive surgery that we follow:

• Multidisciplinary team approach.

• Appropriate selection of the procedure for each patient, ‘à la carte’.

• Immediate reconstruction in a single surgical procedure.

• Prevent complications that delay adjuvant treatment.

• Use of well vascularized tissues.

• Avoid using irradiated tissues.

• Minimize morbidity in donor areas.

• Quality of life (aesthetic and functional result).

Conclusion

• Vulvoperineal reconstruction is a challenge in vulvar cancer surgeries, since it involves the oncological approach and the consideration of the consequences at a functional and aesthetic level, impacting the quality of life.

• In these interventions, knowledge of various reconstructive techniques is required, through the use of flaps.

• A multidisciplinary approach is recommended, with the participation of Plastic Surgery and teams with experience in different techniques, to limit the potential morbidity associated with the treatments.

Disclosures None.