Belhoste M, Bauquis O, Mathevet P, Billy J, di Summa P G
Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
Department of obstetrics and gynecology, Cemtre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
Case Reports Plast Surg Hand Surg. 2024 Aug 13;11(1):2387032. doi: 10.1080/23320885.2024.2387032. eCollection 2024.
Full labia minora reconstruction can be necessary due to congenital malformation or genetic syndromes, but more often is required following oncologic excisions, or debridements after vulvar or perineal infections. It is important to note that full labia reconstruction can be needed after genital mutilation, or iatrogenic deformity after previous labia reduction procedure. A 37-year-old female patient, with vulvar necrotizing fasciitis after a marsupialization of the right Bartholin's gland, was referred to the Gynecology and Obstetrics unit. Three surgical debridements were performed, associated with prolonged antibiotic therapy, leading to a total loss of the right labia minora and the clitoris glans, in addition to minimal loss of labia majora. With a two-stage approach on the labia minora, the first procedure allowed to pull the left labia minora as a labia sharing flap, in order to join the remnant scar tissue on the right side, respecting the anterior and posterior leaflets. The second part was performed five weeks later, after autonomization of the new labia minora flap. Once the flap was divided, a perfectly vascularized right neo-labia minora was obtained. The flap healed uneventfully. The patient was asked to complete a questionnaire at six months, which confirmed an excellent aesthetic result with a like with like reconstruction. Eight months later, a final correction was performed to enhance the definitive aesthetic aspect with lipofilling of the right labia majora. Two techniques have been previously published with a two-stage cross-labial transposition flap, one using a top cut leading to a bottom pedicle and another using a bottom cut with an upper pedicle. We proceeded with a one-time edge resection, respecting the full vascular pedicle and transposed the full height of the labia minora. This technique revealed to be extremely effective, guaranteeing a reliable vascularization and decreasing the risk of tearing on the pedicle.
由于先天性畸形或遗传综合征，可能需要进行完整的小阴唇重建，但更多情况下是在肿瘤切除后，或在外阴或会阴感染后进行清创术后需要。需要注意的是，在女性生殖器切割后，或在先前的小阴唇缩小手术后出现医源性畸形后，可能需要进行完整的阴唇重建。一名37岁的女性患者，在右侧巴氏腺造口术后发生外阴坏死性筋膜炎，被转诊至妇产科。进行了三次外科清创术，并联合延长抗生素治疗，导致右侧小阴唇和阴蒂龟头完全缺失，大阴唇也有少量缺失。采用两阶段法进行小阴唇重建，第一步手术将左侧小阴唇作为阴唇共享皮瓣牵拉，以连接右侧的残余瘢痕组织，保留前后叶。第二部分在五周后进行，此时新的小阴唇皮瓣已自行成活。一旦皮瓣分离，就获得了一个血运良好的右侧新小阴唇。皮瓣愈合顺利。患者在六个月时被要求完成一份问卷，结果证实重建效果极佳，达到了相似的外观。八个月后，进行了最终矫正，通过对右侧大阴唇进行脂肪填充来提升最终的美观效果。此前已发表了两种使用两阶段跨阴唇转位皮瓣的技术，一种是顶部切口形成底部蒂，另一种是底部切口形成上部蒂。我们采用了一次性边缘切除，保留完整的血管蒂，并将小阴唇的整个高度进行转位。该技术显示出极其有效，保证了可靠的血运，并降低了蒂部撕裂的风险。
