Labia Majora Symmetrization Using De-epithelialized Deep External Pudendal Artery Tubular Flap

Summary:

This case report presents a novel technique for reconstructing posttraumatic asymmetrical labia majora using a deep external pudendal artery tubular flap. A 20-year-old woman experienced deviation of the urinary stream during micturition as a result of vulvar sequelae following a motorcycle accident. To address atrophy of the unilateral labia majora, we designed a de-epithelialized deep external pudendal artery tubular flap measuring 3 cm in width and 10 cm in length. The flap was delayed for 2 weeks before transposition, during which the lateral borders were incised down to the crural fascia, and the flap bed was partially undermined. During the second stage of the procedure, we de-epithelialized the external epidermal layer, sutured the flap edges in a tubular configuration, and positioned it within the atrophic labia majora pocket. The distal end of the flap was sutured inside the internal labial space for fixation, and the donor site was closed primarily. At the 6-month follow-up, the patient demonstrated satisfactory symmetrization of the labia majora and correction of the deviated urinary stream during urination. The technique achieved both functional improvement and aesthetic restoration of vulvar symmetry and proved to be promising for managing similar posttraumatic deformities in the genital region.