Complications After Vulvar and Perineal Reconstruction With a Lotus Petal Flap

Background Lotus petal flaps are often used to reconstruct defects in the vulvoperineal area. Wound complications occur more often after surgery in the vulvoperineal area than in other areas of the body. Postoperative complications have a great impact on patients' well-being, length of hospital stay, care needed, and return to participation in daily life. Therefore, it is important to determine which patients are more prone to develop complications.

Methods All lotus petal flap reconstructions in our center between January 2004 and August 2014 were retrospectively reviewed. Complications were categorized by the Clavien-Dindo classification.

Results Ninety-three patients with 137 flaps were reviewed. The complication rates did not differ significantly between the reconstruction areas. In 30.1% of subjects, no complications were reported. A total of 51.7% of the subjects experienced Clavien-Dindo grade I or II complications, which required no or minor intervention. In 18.3% of subjects, intervention was required under general anesthesia (Clavien-Dindo grade IIIb complications), usually for debridement (64.7%). Donor site morbidity occurred in 14.0% of the subjects. The age group younger than 60 years showed a significantly higher rate of complications compared with the group older than 60 years (P = 0.015; odds ratio, 0.235; 95% confidence interval, 0.073-0.754).

Conclusions This is the largest study to date on the complications of the lotus petal flap reconstruction. Complication rates did not differ between vulvar, perineal, and vulvoperineal reconstruction. Young patients seem to have a higher risk of developing complications.