Traditionally, vaginal agenesis reconstruction has involved nonsurgical regular dilatation and surgical creation following skin graft resurfacing.2 Revision is often inevitable for poor compliance on dilatation. An intestinal flap is a good physiologic substitute.3 However, unpleasing scar and discharge and risk of intestinal adhesion limit its application. Myocutaneous flaps are usually too bulky for vagina agenesis reconstruction.4 A pudendal thigh flap presents a good option with a reliable blood supply, an easily hidden donor scar, and a simple technique.5 The only drawback is hair growth and the requirement for bilateral flaps to form a tube-shaped neovagina and achieve wound primary closure.5 The unilateral external pudendal artery perforator flap is a refinement to include a longer, hairless skin flap from the medial thigh based on its perforators.
The perforator-based flap has a longer pedicle than an island pedicle flap, with an equally reliable blood supply. The perforator flap design is more versatile, without the restriction of pedicle direction and length. A longitudinal flap design along the long axis of the thigh is a better design to achieve a longer flap and allow primary donor wound closure. The tension of wound closure on groin skin is larger in a transverse direction than in the vertical direction. A unilateral donor site is adequate for vaginal reconstruction and the donor wound can be closed primarily if the flap width is less than 7 cm. It saves time on flap dissection and inset. A scar in the medial thigh is acceptable. Minimal hair growth of medial thigh skin in the neovagina will be less troublesome. The pedicled, unilateral, external pudendal artery perforator flap is a reliable one-stage procedure with adequate flap size, thin and hairless skin, and minimal donor-site morbidity for the reconstruction of congenital vagina agenesis.
Jung-Ju Huang, M.D.
Chien-Min Han, M.D.
Chyi-Long Lee, M.D., Ph.D.
Ming-Huei Cheng, M.D., M.H.A.
1. Templeman CL, Lam AM, Hertweck SP. Surgical management of vagina agenesis. Obstet Gynecol Surg
2. Michala L, Cutner A, Creighton SM. Surgical approaches to treating vaginal agenesis. BJOG
3. Chen HC, Chana JS, Feng GM. A new method for vaginal reconstruction using a pedicled jejunal flap. Ann Plast Surg
4. Casey WJ III, Tran NV, Petty PM, Stulak JM, Woods JE. A comparison of 99 consecutive vaginal reconstructions: An outcome study. Ann Plast Surg
5. Wee JT, Joseph VT. A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: A preliminary report. Plast Reconstr Surg
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