Perforator flaps for vulvar reconstruction: basic principles

Perforator flaps for vulvar reconstruction: basic principles


  • Edoardo Raposio Genova - Chirurgia Plastica Ricostruttiva ed Estetica - Terapia Cura Emicrania Cefalea.
  • Melita Moioli
  • Giorgio Raposio
  • Stefano Spinaci
  • Angelo Cagnacci


Vulvar cancer; vulvar reconstruction; perforator flaps.


Background and aim: In vulvar cancer, the standard treatment is radical local excision, with immediate reconstruction. Reconstruction aims to restore anatomy and function of the external female genitalia, facilitating preservation of normal body image, sexual function, and micturition and defecation functions. Methods: The purpose of this paper is to describe the principles of perforator flaps for vulvar reconstruction. Results: Basic concepts, indications and operative technique are discussed and detailed. Conclusions: In vulvar reconstruction, the use of perforator flaps is a superior surgical technique when compared to the use of conventional flaps.


: Wohlmuth C, Wohlmuth-Wieser I. Vulvar malignancies: an interdisciplinary perspective. J Dtsch Dermatol Ges. 2019 Dec;17(12):1257-76.

: Ang C, Bryant A, Barton DP, Pomel C, Naik R. Exenterative surgery for recurrent gynaecological malignancies. Cochrane Database Syst Rev. 2014 Feb 04;(2):CD010449.

: Zhang W, Wang Y, Chen W, Du J, Xiang L, Ye S, Yang H. Verrucous Carcinoma of the Vulva: A Case Report and Literature Review. Am J Case Rep. 2019 Apr 19;20:551-556.

: Boer FL, Ten Eikelder MLG, Kapiteijn EH, Creutzberg CL, Galaal K, van Poelgeest MIE. Vulvar malignant melanoma: Pathogenesis, clinical behaviour and management: Review of the literature. Cancer Treat Rev. 2019 Feb;73:91-103.

: Long B, Schmitt AR, Weaver AL, McGree M, Bakkum-Gamez JN, Brewer J, Cliby WA. A matter of margins: Surgical and pathologic risk factors for recurrence in extramammary Paget's disease. Gynecol Oncol. 2017 Nov;147(2):358-363.

: Aartsen EJ, Albus-Lutter CE. Vulvar sarcoma: clinical implications. Eur J Obstet Gynecol Reprod Biol. 1994 Sep;56(3):181-9.

: Argenta PA, Lindsay R, Aldridge RB, Siddiqui N, Burton K, Telfer JR. Vulvar reconstruction using the "lotus petal" fascio-cutaneous flap. Gynecol Oncol. 2013 Dec;131(3):726-9.

: Yamamoto T, Yamamoto N, Kageyama T, et al. Definition of perforator flap: What does a "perforator" perforate? Glob Health Med. 2019; 1(2):114-6.

: Kim JT. New nomenclature concept of perforator flap. Brit J Plast Surg 2005; 58:431–40.

: Abdelfattah U, Power HA, Song S, Min K, Suh HP, Hong JP. Algorithm for Free Perforator Flap Selection in Lower Extremity Reconstruction Based on 563 Cases. Plast Reconstr Surg. 2019 Nov;144(5):1202-1213.

: Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e419-e426.

: Blondeel PN, Van Landuyt KH, Monstrey SJ, et al. The "Gent" consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003 Oct;112(5):1378-83; quiz 1383, 1516; discussion 1384-7.

: Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg. 2003 Jan;50(1):90-9.

: Tan BK, Kang GCW, Tay EH, Por YC. Subunit principle of vulvar reconstruction: Algorithm and outcomes. Arch Plast Surg 2014 July; 41(4):379-86.







How to Cite

Perforator flaps for vulvar reconstruction: basic principles. Acta Biomed [Internet]. 2022 Oct. 26 [cited 2024 Apr. 17];93(5):e2022076. Available from:

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