Lee Yunjae, Lee Sanghun, Lee Dongkyu, Yeo Hyeonjung, Park Hannara, Park Hyochun
Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea.
Arch Plast Surg. 2022 Dec 13;49(6):724-728. doi: 10.1055/s-0042-1756294. eCollection 2022 Nov.
Various flaps are used to reconstruct skin and soft tissue defects of the vulva following resection of malignancies. Whenever possible, reconstruction using local flaps is the standard treatment. Here, we describe vulvar defect reconstruction using keystone flaps. Standard keystone flaps are based on randomly located vascular perforators. However, we designed a keystone flap that includes perforators of three named arteries (the anterior labial artery of the external pudendal artery, cutaneous branches of the obturator artery, and posterior labial artery of the internal pudendal artery) and the pudendal nerve, which accompanies the internal pudendal artery. Four patients with squamous cell carcinoma and extramammary Paget's disease of the vulva underwent radical vulvectomy and keystone flaps including perforators of three arteries. Depending on the morphology of the defects, keystone flaps were used with different designs. For elliptical and unilateral vulvar defects, a standard keystone flap was designed, and for defects on both sides of the vulva, a double opposing keystone flap was used. For oval defects, the omega variant keystone flap was designed, and when the morphology of the defect needed rotation of the flap, a rotational keystone flap was designed. All the patients showed good function and sensation, with an acceptable cosmetic appearance.
在恶性肿瘤切除术后，各种皮瓣被用于重建外阴的皮肤和软组织缺损。只要有可能，使用局部皮瓣进行重建是标准治疗方法。在此，我们描述使用关键皮瓣进行外阴缺损重建。标准关键皮瓣基于随机定位的血管穿支。然而，我们设计了一种关键皮瓣，其包含三条命名动脉（阴部外动脉的阴唇前动脉、闭孔动脉的皮支以及阴部内动脉的阴唇后动脉）的穿支以及与阴部内动脉伴行的阴部神经。四名患有外阴鳞状细胞癌和乳房外佩吉特病的患者接受了根治性外阴切除术以及包含三条动脉穿支的关键皮瓣手术。根据缺损的形态，关键皮瓣采用不同的设计。对于椭圆形和单侧外阴缺损，设计标准关键皮瓣；对于双侧外阴缺损，使用双对向关键皮瓣。对于椭圆形缺损，设计ω变异型关键皮瓣；当缺损形态需要皮瓣旋转时，设计旋转关键皮瓣。所有患者均表现出良好的功能和感觉，外观也可接受。
