Anatomical Re-study And Clinical Application Of The Perineal Skin Flap

There are many skin folds in human body which are adapted to the need of movement and also the important marks to divide anatomic regions, i.e. the groin is the skin fold which exists between lower abdomen and anterior thigh, the gluteal-thigh sulcus is skin fold which exists between buttocks and posterior thigh. Correspondingly, the skin fold which exists between pudendum and superior-medial thigh is named pudendal-thigh sulcus, and flaps harvested from pudendal-thigh territories can be called the pudendal-thigh flaps.Vaginal absence may be caused by congenital vaginal dysplasia, radiotherpy or excision of gynecological tumor and other iatrogenic reasons, and then vaginal reconstruction is needed. More than one hundred techniques for vaginal reconstruction described in the literature bears evidence to the fact that an "ideal" approach has not been widely accepted. The neurovascular pudendal-thigh flap posed by Wee and Joseph(1989) from Singapore has been used growing widely because of its good blood supply, best hiddeness of donor site and convenience for transfer. Sometimes, it's also called Singapore's flap. The main reasons why we choose the pudendal-thigh flap as our major direction of our study is that the anatomic base of the flap is still insufficient clear and flap necrosis may occur occasionally.It is considered formerly that the blood vessels of the pudendal-thigh flaps utilized to form a neovagina are posterior labial arteries or obturator arteries. Through anatomic dissection of all afferent and efferent vessels of pudendal-thigh regions in 10 formaldehyde-fixed female cadavers and blood vessels examination using color-flow Doppler ultrasound scanning imagier, we found that (1) the major vessels of pudendal-thigh flaps used to form an neovagina are external branches of posterior labial arteries, and not the main stem itself. We have found the presence of this vessel in 100 percent and its diameter is (0.72±0.26)mm. Flaps pedicled on the main trunks of the posterior labial arteries and arterialized throughout its length by anastomosis between the posterior labial artery and external pudendal artery are another type of perineal skin flap—the vulvoperineal fasciocutaneous flap, and not the pudendal-thigh flap. (2) the anterior cutaneous branches of the obturator artery penetrate deep fascia of thigh and epimysium of the adductor muscles closing against the lower rami of pubis...