# Overcoming the Three-Dimensional Complexity of Vulvar Defects: A Stepwise, Multi-Flap Approach

## TL;DR

This paper presents a new surgical approach using multiple flaps to treat complex vulvar defects, improving both function and aesthetics.

## Contribution

A stepwise, multi-flap surgical technique is introduced to address three-dimensional vulvar defects.

## Key findings

- The multi-flap approach successfully covered defects involving the vaginal wall, anal canal, and perineum.
- Patients reported favorable outcomes in micturition, defecation, coital function, and aesthetics.
- The use of locoregional tissues maximized functional and aesthetic results.

## Abstract

Complex vulvar defects are challenging owing to their three-dimensional characteristics. We introduce a combined flap approach to maximize the use of locoregional tissues. Four patients had defects involving the vaginal wall, anal canal, and perineum, with a size range of 108 to 157 cm
2
. The outcomes were analyzed using a questionnaire regarding micturition, defecation, coital function, introitus opening, and aesthetics. For the vulva, the gluteal fold flap was the primary flap, which was augmented by the mons pubis rotation flap, gracilis muscle flap, pudendal thigh flap, and medial thigh VY advancement flap. The perianal skin and anal defects were covered by the gluteal fold and buttock VY advancement flaps. Patients' satisfaction scores were favorable on follow-up. Our multi-flap approach optimized the aesthetic and functional results of combined vulvar–anal defects.