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Reconstruction after vulvar surgery | CION Cancer Clinics
Vulvar reconstruction usually means moving nearby skin, with its own blood supply, to close a wound too large or too tight to stitch. This is called a flap. Most women do not need one. When a flap is used, the aim is a wound that heals well, not a vulva that looks as before. This page explains the types, what recovery involves, and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is reconstruction after vulvar surgery?
- What kinds of reconstruction are used?
- What happens if you have a flap?
- How does closing directly compare with a flap?
- What do women expect from reconstruction that is not quite true?
- Who is a flap less suitable for, and what should you ask?
- What do the words on your consent form mean?
- Common questions about reconstruction after vulvar surgery
The short answer
What is reconstruction after vulvar surgery?
Reconstruction after vulvar surgery usually means moving nearby skin, with its own blood supply, to close a wound too large to stitch together. This moved tissue is called a flap. Most women do not need one, because most vulval wounds can be closed directly.
When a flap is considered
A surgeon thinks about a flap when a lot of skin has to be removed, when stitching the edges together would pull too tightly, or when the wound would narrow the openings of the vagina, urethra or back passage. It is also considered when the area has had radiotherapy before, because that skin heals poorly on its own.
What a flap is for
The main aim is a wound that heals, not a vulva that looks as it did before. A flap brings healthy skin with a good blood supply into the gap. That can lower the strain on stitches, reduce tightness, and make sitting and walking more comfortable.
Who does it
Sometimes the gynaecological cancer surgeon does the flap. Sometimes a plastic surgeon joins the same operation. Occasionally reconstruction is done later, as a separate operation.
The main options
What kinds of reconstruction are used?
Your surgeon chooses based on the size and position of the wound, your body shape and any earlier treatment.
Local flaps
Skin right beside the wound is lifted and slid or turned into the gap. These are the most common and leave scars close to the vulva.
Names you may hear
- V-Y advancement flap
- Rhomboid or rotation flap
Buttock-crease flaps
Skin from the fold where the buttock meets the thigh is moved forward. The scar hides in that fold. A lotus petal flap is one example.
Thigh flaps
For larger wounds, skin, and sometimes a muscle, from the inner or outer thigh is brought up to fill the space. This leaves a longer scar on the thigh.
Skin grafts
A thin layer of skin is shaved from the thigh and laid over the wound. It has no blood supply of its own, so it suits shallow wounds better than deep ones.
Not sure whether this applies to you?
Ask an oncologistFrom planning to home
What happens if you have a flap?
Planning
The surgeon explains which flap may be used, where the extra scar will be, and why. Skin may be marked before the operation.
The operation
The cancer is removed first, then the flap is moved and stitched. This makes the operation longer than a vulvectomy alone.
In hospital
Nurses check the flap's colour and warmth often. You may be asked to limit sitting and keep your legs in certain positions for a while.
At home
Two wounds need care: the vulva and the place the skin came from. Avoid pressure on the flap until your team says it is safe.
Side by side
How does closing directly compare with a flap?
Closed directly with stitches
Closed with a flap
One wound, at the vulva
Two wounds, the vulva and where the skin came from
A shorter operation
A longer operation, sometimes with a plastic surgeon
Suits small and medium wounds
Considered for large or tight wounds, or skin treated with radiotherapy
Stitches may pull or open under tension
Less tension, but part of the flap can fail to take
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Commonly believed
What do women expect from reconstruction that is not quite true?
"Reconstruction will make it look exactly as before."
A flap closes the wound and can improve shape and comfort. It cannot rebuild the lips of the vulva or the clitoris as they were. The skin may differ in colour, texture or hair from the skin around it.
"Needing a flap means my cancer is worse."
A flap reflects the size and position of the wound, not how serious the cancer is. A cancer in a tight spot near the urethra can need a flap even when it is small.
"Every woman should ask for a flap to be safe."
A flap adds a second wound, a longer operation and its own problems. When a wound can be closed directly, that is usually the simpler route. Your team weighs this for your wound.
"Once the flap looks pink, nothing can go wrong."
Flaps are watched closely because the edges can still open or become infected in the weeks after. Keep follow-up visits and report any darkening, bad smell or new pain.
Being straight with you
Who is a flap less suitable for, and what should you ask?
Flaps depend on a good blood supply. Smoking, poorly controlled diabetes, severe blood vessel disease and being very frail all make it more likely that part of the flap will not survive. For some women a longer operation carries more risk than a slower-healing wound left to close on its own.
Questions to ask your centre
Ask whether your wound is expected to close directly. If a flap is likely, ask which kind, where the second scar will be, and whether a plastic surgeon will be part of the operation. Ask how long you may need to avoid sitting, and what the plan is if part of the flap does not take.
What the family can do to help
After a flap, the first weeks at home involve more lying down and less sitting than many families expect. A son or daughter can help by setting up a bed with extra pillows, keeping the second wound clean and dry, and noticing early if the flap looks darker or smells bad. Bring the family member who will care for you to the discharge talk, so the instructions are heard twice.
What this page cannot tell you
It cannot tell you whether you need a flap. That is often decided at the planning stage, and sometimes changed during the operation once the surgeon sees how much has to be removed. Your surgeon should explain both possibilities before you consent.
On your consent form
What do the words on your consent form mean?
- Flap
- Skin, and sometimes fat or muscle, moved from nearby while still attached to its own blood supply.
- Donor site
- The place the flap or graft was taken from, which becomes a second wound.
- Skin graft
- A thin layer of skin moved without a blood supply, relying on the wound bed to feed it.
- Flap necrosis
- Part of the flap dying because too little blood reaches it. It may need dressings or further surgery.
- Wound breakdown
- The edges of a wound coming apart before it has healed.
Questions we are asked
Common questions about reconstruction after vulvar surgery
Will I need flap surgery after my vulvectomy?
Most women do not. A flap is considered when the wound is large, would be too tight to stitch, would narrow an opening, or is in skin treated with radiotherapy. Your surgeon can tell you before the operation whether a flap is likely, and should explain that plans can change during surgery.
Can reconstruction be done later instead?
Sometimes. A few women have reconstruction later to release a tight scar or improve comfort. Most flaps are done at the same time as the vulvectomy, because closing the wound well at the start helps it heal. Ask your surgeon which approach fits your situation.
Where will the extra scar be?
It depends on the flap. Local flaps leave scars close to the vulva. Buttock-crease flaps leave a scar in the fold under the buttock. Thigh flaps leave a longer scar on the thigh. Ask to have it shown or sketched before the operation.
Will I be in hospital longer with a flap?
Often a little longer, because nurses watch the flap closely and you may need to limit sitting at first. How long depends on the size of the flap and how quickly you recover. Your team will give you an estimate once the plan is clear.
What happens if the flap does not take?
If part of it loses its blood supply, the edge may darken or open. Small areas often heal with dressings over time. A larger area may need further surgery. Tell your team straight away if the flap turns dark, cold, smells bad or becomes more painful.
Does a flap change how sex feels?
The flap skin usually has less feeling than the skin that was removed. By reducing tightness, though, a flap can sometimes make the vaginal opening more comfortable than a tightly stitched wound would. Ask your surgeon how the planned flap may affect the entrance.
I smoke. Does that matter?
Yes. Smoking narrows small blood vessels, which raises the chance that part of a flap or wound will not heal. Stopping before surgery helps, and your team can support you. Tell them honestly how much you smoke, including beedis or chewed tobacco.
Is reconstruction covered by insurance or schemes?
When a flap is part of the cancer operation, it is usually treated as part of that surgery rather than a cosmetic procedure. Coverage under Aarogyasri, CGHS, ECHS, EHS or cashless insurance depends on your scheme and policy, so ask the billing team to check before the operation.
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Sources
- Cancer Research UK — Vulval cancer
- Macmillan Cancer Support — Vulval cancer
- American Cancer Society — Vulvar cancer
- National Cancer Institute — Vulvar cancer treatment (PDQ)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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