[Application of the lobulated flap or unilobular flap pedicled with the descending branch of lateral femoral circumflex artery in reconstruction of defects resulted from perineal and hypogastric tumor resection].

Objective: To summarize the clinical application of the lobulated flap or unilobular flap pedicled with the descending branch of lateral femoral circumflex artery in reconstruction of defects resulted from perineal and hypogastric tumor resection.

Methods: From September 2010 to June 2014,according to the characteristics of the tissue defects after perineal or hypogastric tumor resection, and also based on the anatomical characteristics of the perforator artery which derived from the descending branch of lateral circumflex artery, unilobular skin flap or bilobulate skin flap was designed for one-stage reconstruction.7 males and 10 females, aged from 34 to 72 years old (average,56 years old), were included. There were 6 cases of dermatofibrosarcoma protuberance (DFSP),7 cases of squamous-cell carcinoma and 4 cases of Bowen disease. Tumors in 7 patients were located in hypogastrium and 10 in perineum. The defects size after tumor resection ranged from 3 cm × 4 cm to 8 cm × 16 cm. Among the patients,13 cases were treated with unilobular flaps, of which the area ranged from 6 cm × 10 cm to 13 cm × 18 cm;4 cases were treated with bilobular flaps, of which the area ranged from 3 cm ×5 cm to 8 cm ×12 cm.The wounds at donor sites were closed directly in 13 patients, and covered with skin graft in 4 patients. All patients underwent tumor extensive resection and subsequently reconstruction with flaps. The clinical courses ranged from 3 to 24 months.

Results: All the flaps survived without vascular crisis. The wounds and incisions at donor sites healed primarily.12 patients were followed up for 3 to 26 months. The average follow-up duration was 16 months.During the follow-up period, the flaps were in good color and texture. Furthermore, patients were satisfied with vulvar appearance and even their sex life.Local tumor recurrence was not observed during the follow-up period.

Conclusion: The flap pedicled with the descending branch of lateral femoral circumflex artery has a relatively long vascular pedicle, which may meet the requirement for reconstruction of defects in perineal and hypogastric region. Moreover, this flap could be designed as lobulated flap to repair two wounds at one-stage.This flap is an ideal option for reconstruction of perineal and hypogastric soft tissue defects with a reliable blood supply and unobvious donor sites.