Labia Majora Share

Defects involving specialised areas with characteristic anatomical features, such as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures. The vulva, a complex 3-dimensional structure, can also be reconstructed through a sharing procedure drawing upon the contralateral vulva. In this report, we present the interesting case of a patient with chronic, massive, localised lymphedema of her left labia majora that was resected in 2011. Five years later, she presented with squamous cell carcinoma over the left vulva region, which is rarely associated with chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy defect with a labia majora sharing procedure is novel and has not been previously described. The labia major flap presented in this report is a shared flap; that is, a transposition flap based on the dorsal clitoral artery, which has consistent vascular anatomy, making this flap durable and reliable. This procedure epitomises the principle of replacing like with like, does not interfere with leg movement or patient positioning, has minimal donor site morbidity, and preserves other locoregional flap options for future reconstruction. One limitation is the need for a lax contralateral vulva. This labia majora sharing procedure is a viable option in carefully selected patients.

Keywords

Perineum - Lymphedema - Carcinoma, squamous cell

We would like to acknowledge Ms Ong Ee Sin Arielle for her illustration.

Publication History

Received: 14 August 2016

Accepted: 27 September 2016

Article published online:
20 April 2022

• REFERENCES

• 1 Nguyen AT, Ramsden AJ, Corrigan BE. et al. Labial reconstruction with a cross-labial flap. J Plast Reconstr Aesthet Surg 2011; 64: 1383-1385
• 2 Zeplin PH, Nuwayhid R, Nuwayhid M. Two-stage posterior cross-labial transposition flap: a novel technique for labium minus reconstruction. Aesthetic Plast Surg 2014; 38: 930-932
• 3 Farshid G, Weiss SW. Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma. Am J Surg Pathol 1998; 22: 1277-1283
• 4 Shelley WB, Wood MG. Transformation of the common wart into squamous cell carcinoma in a patient with primary lymphedema. Cancer 1981; 48: 820-824
• 5 Furukawa H, Yamamoto Y, Minakawa H. et al. Squamous cell carcinoma in chronic lymphedema: case report and review of the literature. Dermatol Surg 2002; 28: 951-953
• 6 Ruocco V, Schwartz RA, Ruocco E. Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol 2002; 47: 124-127
• 7 Gomes CA, Magalhaes CB, Soares Jr C. et al. Squamous cell carcinoma arising from chronic lymphedema: case report and review of the literature. Sao Paulo Med J 2010; 128: 42-44
• 8 Parthiban R, Kaler AK, Shariff S. et al. Squamous cell carcinoma arising from congenital lymphedema. SAGE Open Med Case Rep 2013; 1: 2050313X13496507
• 9 Hadway P, Lynch M, Corbishley CM. et al. Squamous cell carcinoma of the penis in a patient with chronic isolated penile lymphoedema. Urol Int 2006; 76: 87-88
• 10 Abhyankar SV, Kulkarni A, Kulkarni M. et al. Squamous cell carcinoma of the penis and scrotum in a patient with chronic scrotal and penile lymphedema. Indian J Dermatol 2010; 55: 387-389
• 11 Su TF, Lee HS, Gao HW. et al. Squamous cell carcinoma arising from massive localized lymphedema of scrotum mimicking scrotal smooth muscle hamartoma of dartos: a case report. Am J Dermatopathol 2015; 37: 551-554
• 12 Sideri M, Jones RW, Wilkinson EJ. et al. Squamous vulvar intraepithelial neoplasia: 2004 modified terminology, ISSVD Vulvar Oncology Subcommittee. J Reprod Med 2005; 50: 807-810
• 13 Alkatout I, Schubert M, Garbrecht N. et al. Vulvar cancer: epidemiology, clinical presentation, and management options. Int J Womens Health 2015; 7: 305-313
• 14 Hockel M, Dornhofer N. Vulvovaginal reconstruction for neoplastic disease. Lancet Oncol 2008; 9: 559-568
• 15 Hage JJ, Beurden M. Reconstruction of acquired perineovulvar defects: a proposal of sequence. Semin Plast Surg 2011; 25: 148-154