Pedicled vertical posteromedial thigh (vPMT) flap for the reconstruction of extensive perianal-genital defects.

INTRODUCTION: Perianal and genital defects occur because of a vast etiology making the reconstruction of function and esthetics remain challenging. Depending on the extent of the defect, different techniques have been employed for coverage including skin grafts, local skin flaps, musculocutaneous flaps, and pedicled perforator flaps. The pedicled vertical posteromedial thigh (vPMT) flap is a new perforator flap that has rarely been employed for this kind of reconstruction. The purpose of this article is to focus on the vPMT perforator flap, which is mainly used as a propeller flap, for reconstructing the perianal and genital region as a feasible option in this area. PATIENTS AND METHODS: From July 2013 to December 2018, we treated twelve patients with extensive perianal and/or genital defects with 21 pedicled vPMT flaps. Three patients needed unilateral reconstruction, while 9 patients bilateral needed bilateral reconstruction. The location of the defects included the scrotal region (3 cases), the perianal region (8 cases), and the vulvar region (5 cases), whereby some cases had combined defects. RESULTS: The flap sizes varied from 5-9 cm in width to 18-35 cm in length and all flaps were harvested as perforator-based island flaps. The flap movements used for defect coverage included V-Y advancement in three cases and rotation in propeller fashion in eighteen cases. All flaps survived without any major complications and all donor sites were closed primarily. CONCLUSION: Our case series showed an exemplary model for the coverage of the perianal and genital region by using the pedicle vPMT flap and the achievement of a sustainable treatment with a minor morbidity of the donor site. We believe that the vPMT flap could be an alternative option for the reconstruction of the perianal and genital region and could be inserted in the armamentarium of the reconstructive microsurgeon.

Reconstruction of a large pelvic defect by transfer of a quadruplet combination of pedicled flaps from the medial thigh using bilateral muscular gracilis flaps and bilateral vertical posteromedial thigh (vPMT) propeller flaps-A case report.

The reconstruction of defects of the perianal area and vagina places a high demand on a reconstructive surgeon. Different reconstructive methods include a skin graft, a local skin flap, a musculocutaneous flap, and a pedicled perforator flap. Here, we report the case of a 59-year-old female patient with a pelvic defect, who underwent reconstruction with a quadruplet combination of pedicled flaps from the medial thigh, due to an extensive resection of a recurrence of a squamous cell carcinoma of the anus, vulva, and partially the colon. The surgical oncologist performed a rectum amputation, a partial colectomy, a complete hysterectomy, and a resection of the dorso-lateral vaginal vault in order to achieve tumor-free margins. The resulting defect measured 14 × 11 cm2 with 8 cm of deep space. The defect was covered and reconstructed by employing a bilateral pedicled gracilis muscle flap rotated about 120° and advanced to fill up the residual spare space in the deep and a bilateral vertical posteromedial thigh (vPMT) using a propeller flap measuring 27 × 10 cm2 rotated 180° in order to reconstruct the vagina and the perianal area. All flaps survived without major post-operative complications. The donor site morbidity was minimal. The range of motion was not limited over both hip and knee joints. Patient had no problem with urination. Sexual intercourse was not highly considered due to patient's old age. The follow-up at 6 months showed acceptable cosmetic results with a satisfying contour of the coverage and reconstructed area. The combination of pedicled gracilis muscle flap and vPMT propeller flap may represent a valuable option in such a defect where deep space obliteration and reconstruction of the vagina with perianal contouring are needed.