Refined DIEP Flap Technique for Vaginal Reconstruction

Objectives

To report our experience with vaginal reconstruction with the deep inferior epigastric perforator (DIEP) flap. Vaginal reconstruction can be accomplished with a variety of flaps, depending on the defect. The use of perforator flaps, however, is still uncommon.

Methods

From June 2007 to April 2008, 5 patients with congenital vaginal absence and 1 patient with a total vaginectomy defect after ablative surgery underwent total vaginal reconstruction with pedicled DIEP flaps. Preoperative mapping of the perforators was performed using enhanced computed tomography (CT) scanning with three-dimensional reconstruction. The desired perforators were selected according to their diameters and intramuscular courses. The vertically oriented DIEP flaps were then raised and tubed to form the neovagina, which was brought to the prerectal pocket through a retropubic tunnel.

Results

All flaps survived in their entirety. Wound infection occurred in 1 patient, and secondary healing was achieved with local wound care. The mean follow-up was 5 months. The vaginal depth remained stable, without evidence of orifice constriction.

Conclusions

The vertical DIEP flap is a reliable option for total vaginal reconstruction with consistent results. It spares the rectus abdominus muscle when a muscle flap is not required.