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PR059/#1230  A modification of the keystone perforator island flap in vulvo-perineal reconstruction following vulvectomy
  1. Aisling Mc Donnell1,
  2. Donal Brennan1,
  3. Claire Thompson1,
  4. Tom Walsh1,
  5. Ruaidhri Mcvey1,
  6. Edward Corry1,
  7. Michael Wilkinson1,
  8. Áine Lucey2 and
  9. Richard Hanson2
  1. 1Mater Misericordiae University Hospital, Gynaecologic Oncology, Dublin, Ireland
  2. 2Mater Misericordiae University Hospital, Plastic and Reconstructive Surgery, Dublin, Ireland

Abstract

Introduction Conventional flaps in perineal reconstruction can result in significant donor site morbidity. Advances in reconstructive surgery have led to the development of the perineal perforator flap (PPF) and the random island perineal perforator flap (RI-PFF); the latter eliminating the need for extensive perforator dissection. To build on this further, we provide a case series describing the use of a Keystone perforator island flap (KPIF). The KPIF is raised based on the ‘perforator-rich’ region at the posterolateral vulva; an anterior Z-plasty offers protection of the clitoral hood, while a posterior V-Y-plasty allows for an aesthetically pleasing, tension-free primary closure of the donor site.

Methods A retrospective study was conducted of patients who underwent vulvectomy with concurrent KPIF reconstruction at the Mater Hospital, Dublin, between 2015 and 2023.

Results 12 patients (age range 34 to 80) underwent vulval reconstruction following vulvectomy (6 unilateral, 6 bilateral). Indications included both pre-invasive and malignant disease of the vulva. All reconstructions were performed by a single operator. There were no cases of flap loss or donor-site complications, as defined by wound infection, dehiscence, or keloid formation. All 12 patients reported excellent satisfaction with donor-site aesthetics.

Conclusion/Implications The use of the KPIF eliminates the need to identify perforators intra-operatively, thus reducing operating time. The modified design at the apex, and base of the flap, aims to create a more functional and aesthetically pleasing result. The KPIF is, therefore, a good option for reconstruction post vulvectomy.

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