Coverage of perineal defects in purpose of a case

Abstract

Introduction: Perineal region defects constitute a reconstructive challenge for the plastic surgeon because, depending on the cause and size of the lesion, they may generate greater or lesser locoregional distortion, with possible involvement of the reproductive, urinary, and digestive systems, in addition to being an area of aesthetic relevance. Due to its anatomical and functional complexity, perineal reconstruction remains a region that requires strict case-by-case analysis in order to achieve the best possible coverage.
Objectives: To present a clinical case of perineal reconstruction following wide resection of the labia majora and minora, using the lotus petal flap technique.
Materials and Methods: The lotus petal flap has been used as a reconstructive method in vulvovaginal, anal, and vulvar intraepithelial neoplasms, for reconstruction of the posterior vaginal wall, in severe hidradenitis suppurativa, in giant genital condylomatosis, among other pathologies. Being distant from the lymphatic dissemination pathway makes it the technique of choice in the reconstruction of vulvar squamous cell carcinomas. It was initially described as a fasciocutaneous flap, designed based on the rich anastomosis of perforating vessels arising from the terminal branches of the internal pudendal artery. Subsequently, anatomical studies demonstrated that the fascia was not essential for its vascularization, allowing correction of its main aesthetic disadvantage while maintaining its benefits.
Results: This is a versatile and simple reconstructive technique, which is essential for surgeons with less experience, as it is not a technically demanding flap. Its vascular anatomy makes it a safe and reliable technique with a relatively low complication rate. It allows reconstruction of defects of different sizes, including extensive ones, with a very good final cosmetic result, as evidenced in the clinical case presented.
Conclusions: In accordance with our results and consistent with what has been reported by various authors, the lotus petal flap should be among the options to consider in the reconstruction of perineal defects. We believe it is very important to repair this type of defect with reconstructive techniques that offer the advantages of this flap in terms of innervation, vascularization, simplicity, versatility, minimal morbidity, good cosmetic outcome, low complication rates, and adaptability to different types and sizes of defects.