PURPOSE

The unilateral split gracilis myocutaneous flap for wound coverage of large vulvoperineal defects has not been previously reported for use in the reconstruction following radical vulvectomies.

METHOD

This is a case report of a 75 year old white female with history of non insulin dependent diabetes mellitus, coronary artery disease and hypertension was diagnosed in 2004 with an invasive vaginal squamous cell carcinoma on a routine Pap Smear. She had a hysterectomy performed forty years earlier due to vaginal prolapse (d). The vaginal carcinoma was managed at the time with a partial vaginectomy and post op  external beam high dose radiation therapy for 3 weeks. Two years after the partial vaginectomy she began complaining of vulvar pain and was diagnosed with radiation vulvitis.  In addition to oral antibiotics, she received 30 treatments of hyperbaric oxygen therapy which were completed by 2007 without any significant relief. She was then taken to the operating room for resection of the radiartion necrosis of the vulva and a unilateral split gracilis musculocutaneous flap was performed as part of her vulvo-perineal reconstruction.

RESULTS

The musculocutaneous gracilis flap with preservation of the vascular pedicle derived from the medial circumflex femoral artery was used successfully to correct other complicated perineal soft-tissue defect. The use of this split gracilis allowed the central defect to be reconstructed with a unilateral musculocutaneous flap allowing access to the urethra and introitus, as well as mimicking a labia majora.

CONCLUSION

The split modification of the Gracilis flap allowed complete resurfacing of the defect while preserving the introitus providing a functional result without the use of the contralateral gracilis.