Full labia minora reconstruction with labia sharing flap: a case report

Abstract

Full labia minora reconstruction can be necessary due to congenital malformation or genetic syndromes, but more often is required following oncologic excisions, or debridements after vulvar or perineal infections. It is important to note that full labia reconstruction can be needed after genital mutilation, or iatrogenic deformity after previous labia reduction procedure. A 37-year-old female patient, with vulvar necrotizing fasciitis after a marsupialization of the right Bartholin’s gland, was referred to the Gynecology and Obstetrics unit. Three surgical debridements were performed, associated with prolonged antibiotic therapy, leading to a total loss of the right labia minora and the clitoris glans, in addition to minimal loss of labia majora. With a two-stage approach on the labia minora, the first procedure allowed to pull the left labia minora as a labia sharing flap, in order to join the remnant scar tissue on the right side, respecting the anterior and posterior leaflets. The second part was performed five weeks later, after autonomization of the new labia minora flap. Once the flap was divided, a perfectly vascularized right neo-labia minora was obtained. The flap healed uneventfully. The patient was asked to complete a questionnaire at six months, which confirmed an excellent aesthetic result with a like with like reconstruction. Eight months later, a final correction was performed to enhance the definitive aesthetic aspect with lipofilling of the right labia majora. Two techniques have been previously published with a two-stage cross-labial transposition flap, one using a top cut leading to a bottom pedicle and another using a bottom cut with an upper pedicle. We proceeded with a one-time edge resection, respecting the full vascular pedicle and transposed the full height of the labia minora. This technique revealed to be extremely effective, guaranteeing a reliable vascularization and decreasing the risk of tearing on the pedicle.