Reconstruction of an extensive vulvectomy defect using the gluteus maximus fasciocutaneous V-Y advancement flap

Effective management of a vulvar wound resulting from oncological ablative surgery poses a formidable task for the reconstructive surgeon. During the past two decades, numerous procedures have been described in an effort to provide stable, sensate coverage that minimizes deformity and preserves function, often in the setting of concomitant radiation. At the authors' institution, a fasciocutaneous V-Y advancement flap based on the gluteus maximus has been adopted as a common approach to this problem. They present their institutional experience with this procedure. A 10-year chart review (1991-2001) yielded a series of 20 vulvectomy patients, all of whom were reconstructed by the same surgeon using ischial fasciocutaneous V-Y flaps based on perforators from the inferior border of the gluteus maximus muscle. Patients underwent vulvectomy for recurrent or advance-stage vulvar cancer, or extensive carcinoma in situ. Squamous cell carcinoma was the most common pathology (N = 13). Fifteen patients had bilateral V-Y flaps; the remainder had unilateral procedures. Six patients underwent prior radiation therapy. Two patients had delayed reconstruction for vaginal stenosis. Flap survival was 100%. There were no major complications, early or late. Minor complications were limited to localized areas of delayed healing, all of which responded to conservative measures. Functional outcome was excellent in all patients. At an average follow-up of 44 months, there were five episodes of recurrent disease necessitating surgical intervention. Based on this series, the gluteus maximus V-Y advancement flap provides a straightforward and reliable method to recruit local tissue for stable coverage of these often difficult-to-manage wounds.     

The total gluteus maximus rotation and other gluteus maximus musculocutaneous flaps in the treatment of pressure ulcers

The use of musculocutaneous flaps in the treatment of pressure ulcers has been widely accepted. This study presents the results of the use of various types of gluteus maximus musculocutaneous flaps such as island flaps, advancement flaps and new total gluteus maximus rotation flaps with or without an inferior gluteal fasciocutaneous extension, in the treatment of pressure ulcers.     

Bilateral V-Y advancement flaps for the management of extensive defects of the perianal skin

Premalignant and malignant conditions of the skin may sometimes require excision of extensive areas of the skin and subcutaneous tissues. Coverage of the ensuing raw area may be afforded by allowing healing by secondary intention, skin grafts, or flaps. Wide excision of the perianal skin poses special problems. We describe the use of bilateral V-Y advancement flaps for the management of an extensive defect resulting from the wide excision of squamous cell carcinoma arising in scarred perianal skin.     

Reconstruction of large post-sternotomy wound with bilateral "V-Y fasciocutaneous advancement flaps"

Post-sternotomy wounds are highly dangerous complications after a median sternotomy. Many different methods have been described for reconstruction of post-sternotomy wounds. The treatment is multifactorial. The treatment depends on the severity of the wound and various patient factors. We evaluate a novel method for closure of sternal dehiscence of a patient who has multiple comorbid problems, including diabetes mellitus, hypertension, and chronic obstructive pulmonary disease. In our method, after debridement, the "bilateral V-Y fasciocutaneous advancement flaps" were used for reconstruction. This method presents a successful resolution of an infected median sternotomy wound. It is a simple, rapid, and effective procedure associated with low mortality, morbidity, and short hospital stay.     

Functional reconstruction of large anogenital defects with bilateral V-Y advancement posterior thigh fasciocutaneous flaps.

BACKGROUND: In patients with perianal extramammary Paget's disease, wide local excision is recommended. In the reconstruction of the resulting large defects not only the closure of the defect but also the preservation of anogenital function need to be considered. METHODS: We used bilateral V-Y advancement posterior thigh fasciocutaneous flaps for reconstructing three large anogenital defects, including the total anal canal, resulting from wide local excisions attributed to extramammary Paget's disease. A temporary anus was constructed at the same time to allow the wound of the reconstructed anus to heal. After the surgery, the course of bowel function was followed up through interviews and manometric examinations. RESULTS: All defects were successfully reconstructed with the flaps, and bowel function recovered satisfactorily. Manometric examinations were carried out in two cases; anal pressures were recorded regularly and used as parameters of the recovery of bowel function before closing the artificial anus. Eventually, the patients recovered the function of defecation. CONCLUSIONS: We recommend the bilateral V-Y advancement posterior thigh fasciocutaneous flaps together with manometric studies as one of the most effective techniques for managing large anogenital defects. The use of sensate flaps, the restoration of original structures and manometric studies are conducive to successful outcomes.     

V-Y Bilateral gluteus maximus myocutaneous advancement flap in the reconstruction of large perineal defects after resection of pelvic malignancies

Objective  To evaluate the role of the V-Y bilateral gluteus maximus myocutaneous flap (GLM) in the reconstruction of large perineal defects after wide surgical resections for pelvic malignancies.
Method  Twelve consecutive patients (seven females and five males), of mean age 59 years (36–78), with primary or recurrent pelvic malignancies (rectal, anal and vulvar carcinoma), underwent either abdomino-perineal rectum excision with partial sacrectomy or total pelvic exenteration. The perineal defect was reconstructed by means of a GLM flap. Intra-operative blood loss, operative time, hospital stay, postoperative complications and long-term outcome were retrospectively assessed.
Results  One patient died postoperatively. All the remaining patients had at least one early and/or late complication. After a mean follow-up of 31.2 months, seven patients were alive. No major functional impairment in daily activities was observed. Five patients experienced a slight discomfort in either walking, sitting or cycling.
Conclusion  Gluteus maximus myocutaneus flap is a useful technique for the repair of perineo-pelvic defects after abdomino-perineal rectum excision with partial sacrectomy.     

The gluteus maximus musculocutaneous flap as bilateral V-Y sliding flap or as pendulum flap for closure of sacral and ischial pressure sores

Summary Eight V-Y and fourteen pendulum gluteus maximus myocutaneous flaps have been used in eighteen patients for closure of sacral and ischial pressure sores. The patients have been followed-up for between 3 and 36 months and there was only one recurrence in a patient who had had a bilateral pendulum flap. There has been no functional impairment in the ambulant patients.     

Reconstruction of small to medium defects in the soft tissues of the nose with nasalis musculocutaneous V-Y advancement flaps.

Defects in the soft tissues of the nose are usually reconstructed with skin grafts or frontal flaps. However, skin grafts may cause scar tissue and changes in colour. Frontal flaps, however, may be thicker than normal skin and may give unsatisfactory results. Nasalis musculocutaneous V-Y advancement flaps avoid these disadvantages. We suggest an algorithmic approach for the use of these flaps in the reconstruction of small to medium defects in the soft tissues of various regions of the nose. The pedicles of these flaps are the dorsal and lateral nasal arteries. This approach provides a simple, safe, and reliable reconstruction for small and medium defects in the soft tissues of the nose.     

Reconstruction of a complex intercanthal defect with triple advancement flaps.

A complex intercanthal skin defect, created by resection of a squamous cell carcinoma localised in the nasal root of a 52-year-old man, was successfully reconstructed using three axial pattern advancement flaps raised from the nasal dorsum and paranasal areas.     

Reconstruction of a complex intercanthal defect with triple advancement flaps

A complex intercanthal skin defect, created by resection of a squamous cell carcinoma localised in the nasal root of a 52-year-old man, was successfully reconstructed using three axial pattern advancement flaps raised from the nasal dorsum and paranasal areas.     

Reconstruction of a traumatic hallux amputation using a plantar V-Y advancement flap

A plantar V-Y advancement flap is effective for reconstruction of a hallux amputation. The procedure provides adequate padding with good toe contour, maintains length, and preserves sensation. Technically, the reconstruction is not difficult. Recovery is rapid.     

A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps

BACKGROUND:

Reconstruction of medial canthal defects after tumour excision is difficult owing to the thin skin of the region and the concavity of the anatomical landmarks, which enclose complex structures such as the medial canthal ligament and the lacrimal system. Local reconstruction methods for this region include secondary healing, full-thickness skin grafts, and skin flaps from the frontal, transnasal, glabellar and upper eyelid regions.

OBJECTIVE:

To demonstrate a useful combination of two local flaps in wide defects of the medial canthal region.

METHODS:

Between 1998 and 2012, a combination of glabellar rotation and nasolabial V-Y advancement flaps were used in 11 patients with wide complex defects after excision, including periosteum, of invasive basal cell carcinoma.

RESULTS:

All patients were tumour free and underwent functional and aesthetic reconstruction of the medial canthal region. There were no major complications, and no relapses were observed.

CONCLUSION:

This technique achieves good match in colour and texture, and has satisfactory results both aesthetically and functionally. In addition, donor area morbidity is minimal and surgical technique is simple.     

Idiopathic bilateral gluteus maximus contracture: a case report and review of literature

Bilateral gluteus maximus contracture is an infrequently reported clinical entity. There are only two case reports from the Indian subcontinent. We report a case of idiopathic bilateral gluteus maximus contracture in a 14-year-old girl.     

The V flap: a combination of V-Y advancement and two Limberg transposition flaps

Two annoying problems are encountered in surgical correction of greater defects by flap plasty: the widely undermined cavity seen when using transposition flaps to cover large wound cavities and the necessity to cut away healthy skin because of dog ears or a Burrow's triangle. The V flap is a method of shifting and transposing of the skin surrounding the defect to avoid these troublesome disadvantages. With the exception of cases where a myocutaneous island flap is indicated, this simple V-flap technique yields excellent surgical results.     

Single-stage sacral coccygectomy and repair using human acellular dermal matrix (AlloDerm®) with bilateral gluteus maximus flaps for hernia prophylaxis

Sacrococcygectomy is often necessary for the ablation of malignancies involving the sacrum and coccyx, and can result in deep posterior peritoneal defects with disruption of the pelvic floor. Such a radical procedure is frequently associated with significant morbidity, including sacral herniation. Numerous techniques for the closure of the surgical defect have been described, with varying degrees of success in avoiding future herniation. We report the first single-stage coccygectomy and partial sacrectomy with closure utilizing human acellular dermal matrix (HADM) (AlloDerm^®; LifeCell Corporation, Branchburg, NJ) and bilateral gluteus maximus transposition flaps.     

Combined use of medial thigh skin flaps and gracilis musculocutaneous flaps for the reconstruction of scrotum

Summary A case of combined use of bilateral medial thigh skin flaps and gracilis musculocutaneous flaps for the reconstruction of a scrotal defect resulting from Fournier's gangrene is presented. The procedure provided a sac-like scrotum, and the donor sites were successfully reconstructed using bilateral gracilis musculocutaneous V-Y advancement flaps.