Internal pudendal perforator artery-based gull wing flap for vulvovaginal 3D reconstruction after tumour excision: a new flap.

Various skin tumours such as squamous cell carcinoma and extramammary Paget's disease can occur in the vulval area, and reconstruction of the vulval area can be a very challenging task. A retrospective analysis of vulvar reconstruction using the new method 'internal pudendal perforator artery-based gull wing flap' was performed from April 2012 to December 2013. A perforator vessel from the internal pudendal artery was detected with a portable Doppler and marked, and this was the pivot point around which the flap was rotated. The flap was rotated by more than 150°-180° internally, and the labium and the external wall of the vagina were reconstructed with sufficient volume. Anatomical and aesthetic reconstruction of the labium and the vagina was performed without serious complications. Functional and aesthetic vulvar reconstruction can be achieved by using a flap that provides sufficient volume of the labium. Our new technique, the 'internal pudendal perforator artery-based gull wing flap', is good and it can be used to reconstruct a functional and aesthetically acceptable vulvovagina for large defect wound after tumour excision.