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Elevation of Thin Pudendal Artery Flap Using Fat Thickness Data in Vulvovaginal Reconstruction

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Abstract

Majority of defects after excision of vulvovaginal skin cancers is shallow in depth. A thin flap is thus suitable for pudendal defects. To create a thin pudendal artery flap, the relationship between fat thickness and age or body mass index (BMI) was examined. A total of 12 flaps in 7 cases were enrolled. In the initial 3 cases, five flaps were elevated in the subfascial plane of the gluteus maximus muscle based on the conventional method. In the 4th case with thick adipose tissue, the flap was elevated in the plane just below Camper’s fascia (CF). We then adopted this modified flap elevation method in 7 flaps of the 4th to 7th cases. By using computed tomography, we evaluated the perineal fat thickness (PFT) and gluteal fat thickness (GFT) to determine the thickness of the flap. All flaps survived completely. In all flaps prepared with the modified method, debulking was not required. The mean PFT (34.4 ± 2.8 mm) of the patients less than 70 years of age was significantly higher than that of patients of 70 years or more (21.0 ± 3.5 mm). The mean GFT (18.4 ± 1.1 mm) of the patients with BMI ≥ 25 was significantly higher than that of patients with BMI < 25 (11.8 ± 1.2 mm). To create a thin pudendal artery flap, the method of elevating the flap in the plane just deep to CF should be adopted, especially in patients less than 70 years of age or with BMI ≥ 25.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan

    Masao Fujiwara, Yusuke Ohta & Hidekazu Fukamizu

  2. Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Takahiro Suzuki & Yoshiki Tokura

  3. Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Eisaku Okada

Authors
  1. Masao Fujiwara
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  2. Takahiro Suzuki
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  3. Yusuke Ohta
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  4. Eisaku Okada
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  5. Hidekazu Fukamizu
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  6. Yoshiki Tokura
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Correspondence to Masao Fujiwara.

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The study was approved by the institutional review board and conducted in accordance with the Declaration of Helsinki.

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Informed consent was obtained from each patient and parent. Informed consent has been obtained prior to the use of the photographs.

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Level of Evidence: Level IV, therapeutic study.

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Fujiwara, M., Suzuki, T., Ohta, Y. et al. Elevation of Thin Pudendal Artery Flap Using Fat Thickness Data in Vulvovaginal Reconstruction. Indian J Surg 82, 169–175 (2020). https://doi.org/10.1007/s12262-019-01913-4

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  • DOI: https://doi.org/10.1007/s12262-019-01913-4

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