Vulvar Flaps
V-Y Flap
Basics
This is a versatile surgical technique for tissue advancement and reconstruction. Mechanically, it involves making an incision in the shape of a "V" and then advancing the flap forward while closing the defect in a "Y" configuration. The design is based on local tissue recruitment and relies on maintaining an adequate blood supply while minimizing tension.
The flap's dimensions are crucial for its success: the base of the "V" should be at least as broad as the tissue to be advanced, and the length of the flap is generally around 2-3 times the width of the base.
Careful attention is paid to ensuring that the apex of the "V" is not too acute (minimum 30 degrees), as this can compromise blood flow and lead to tissue necrosis. The flap is advanced primarily through tissue elasticity and limited skin undermining, making it practical for small to moderate defects with minimal donor site morbidity.
VIDEO 1:
Here is an excellent video by Dr. Jean Dubuisson on Youtube
Video 2:
Dr T A Dinh - SGS Video Archive: https://vimeo.com/125482716
How to choose the correct reconstruction
Here is an algorithm from the Journal of Gynecologic Oncology - Access if free for all
Stefano Gentileschi
Video - Vulvar Flaps
Dr. Ken Hatch discusses Vulvar Flaps—techniques for V-Y flaps and strategies to choose the right flap for reconstruction.
Important point: If vulvar tissue has been previously radiated, bring a flap from non-radiated area with fresh blood supply.