Vulvoperineal defects mount significant functional and aesthetic challenges for reconstructive surgeons, often followed by postoperative complications. Ideal flap creation and perforator selection is vital for proper healing, especially in those with comorbid health concerns. This report details an innovative approach to vulvar reconstruction using a freestyle perforator flap from the medial thigh, identified by color flow Doppler ultrasound (CDU). This noninvasive imaging technique made possible the exact identification and confirmation of a well-vascularized pedicle, giving rise to a tailored flap for enhanced postoperative recovery and healing.
The flap was designed based on real-time vascular mapping by CDU and validated through indocyanine green angiography, ensuring robust perfusion. The case of this patient demonstrated the successful application of portable CDU to navigate the intricate vessel network of the medial thigh, which would not have been possible with traditional imaging modalities such as computed tomography alone. The lack of postoperative complications following reconstruction demonstrates how this strategy for addressing vulvoperineal defects is advantageous due to meticulous perforator selection based on the patient’s unique anatomy. CDU is therefore an important tool for achieving optimal outcomes related to form and function, all while reducing the risks of donor site morbidity.
Indocyanine green (ICG) angiography was used to assess flap perfusion, examined via the SPY PHI system, which detected adequate perfusion. A subcutaneous tunnel was created toward the superolateral portion of the wound. The distal end of the flap was thinned and contoured for symmetry with the labia majora. The patient did well postoperatively and was discharged three days later with a 2-week course of intravenous antibiotics.
