Comparison of V-Y Advancement Flap Versus Lotus Petal Flap for Plastic Reconstruction After Surgery in Case of Vulvar Malignancies

Confaloneri, P. L., Gilardi, R., Rovati, L. C., Ceccherelli, A., Lee, J, H., Magni, S., Del Bene, M., & Buda, A. (2017). Comparison of V-Y advancement flap versus lotus petal flap for plastic reconstruction after surgery in case of vulvar malignancies: A retrospective single center experience. Annals of Plastic Surgery; 00 (00), 1-6.

This article is a retrospective cohort study centered at one Italian hospital following one surgical team that sought to evaluate whether the V-Y advancement flap technique or the lotus petal flap technique (and their respective variations) provides a better surgical outcome and postoperative complication rates. Data was collected between 2010 and 2016 and included 234 women, 128 of which underwent the V-Y technique and 106 of which underwent the lotus petal technique. Of note is that the V-Y advancement flap technique was (and continues to be) far more common in vulvar reconstruction cases.

The researchers primarily assessed the incidences of cellulitis, wound infection, flap dehiscence, and partial or total flap ischemia or necrosis as a means of assessing post-surgical outcomes and complications. They found that there was no significant difference in postoperative outcomes between the two flap techniques. They did acknowledge, however, that the lotus petal technique is not suitable when the defect to be repaired is very large. They also pointed out that, particularly in younger patients, the lotus petal flap provided a better cosmetic outcome owing to the easier concealment of the scars in this technique.

The strengths of this article include that there was a decent number of participants, all participants were from the same hospital with the same team which lends an element of standardization in the pre-op, intra-op, and post-op care, there was good follow-up, and the article was published recently in 2017 with data collection within the last 10 years, meaning that it the methods and considerations were relevant. While there was a decent number of participants for this study, more would have lent more power to the results. Other limitations include the fact that the study was conducted in Italy, limiting its potential generalizability to the local population, and the fact that there was no information or assessment done concerning the functionality of the reconstructed area in the follow-up period.