Vulvar reconstruction with pedicled ALT and pudendal flaps, secondary to a mammary-like adenocarcinoma of the vulva associated to Paget´s disease.

Abstract

Vulvar Paget's disease is the most common extra-mammary form, representing 1-2% of vaginal neoplasms.¹ Is included within the primary adenocarcinomas of the vulva, which are rare malignancies, along with sweat gland carcinomas and mammary-like vulvar glands.² Treatment is multidisciplinary, being necessary in advanced cases, a surgical resection with wide margins and subsequent reconstruction. In this paper, we present the case of a 51-year-old patient, who presented a mammary-like adenocarcinoma associated to an extensive vulvar "extramammary Paget" case, not a candidate for conservative management, being initially approached by the onco-surgery service, performing a wide resection of the neoplasm associated with bilateral inguinal lymph node dissection. Subsequently the reconstruction was completed using an anterolateral pedicled thigh flap associated with a double pudendal flap (Singapore) for vulvo-perineal reconstruction. Immediate postoperative surveillance of the flap and follow-up at 1 and 6 months were performed with an adequate aesthetic and functional result.