Use of the bilobed flap in the pubic region after tumoral lesion\nexcision
A fifty-one years old African-American female patient, working as a caregiver for an\nelderly patient, had clinic and histopathological diagnosis of HPV lesions in the pubic\nregion. During 18 months she was submitted to several sessions of electrocoagulation,\ncryotherapy and 5% imiquimod cream, without success. After a two-month absence, the\npatient returned reporting an accelerated growth of the lesion, which on examination\npresented as a tumoral lesion, measuring 5 cm in diameter, with regular, well-defined\nerythematous borders, and a verrucous yellow surface, painful to palpation ().\nThe patient was positive to human immunodeficiency virus (HIV) since 1996, in treatment\nwith antiretroviral drugs, with an undetectable viral load and a CD4 count over 1,000\ncells/ml.\nDue to the therapeutic resistance of the lesion, the co-infection by HIV, the\naccelerated growth and clinical characteristics of the injury, the hypothesis of\ntransformation to spinocellular carcinoma was suggested.\nAn excisional biopsy, with 3 mm security margins was performed. Histopathological\nexamination showed papillomatous epithelial hyperplasia associated to cytophatic viral\neffects, without cellular atypia, with free margins. The hypothesis of local malignant\nneoplasm was excluded, thus confirming the diagnosis of HPV.\nThe residual surgical defect had 6.8 cm in diameter and to reconstruct it a bilobed flap\nwas used, preserving the function, anatomy and the aesthetics of the pubic and genital\nareas ( and ).\nThe surgery was performed under local anesthesia with 2% lidocaine (4 ml), epinephrine\n1mg/ml (0.2 ml), sodium bicarbonate 8.4% (4 ml) and saline solution 0.9% (31.8 ml), plus\nperioperative application of 1 g intravenous cephazolin.\nAfter lobes flap transposition, it was necessary to add two compensatory triangles, the\nfirst one close to the right inguinal fold and the second one on the right suprapubic\nregion. The latter facilitated the closing of the flap on its proximal portion. The\nsimple, interrupted sutures, using 4.0-monofilament nylon were performed without\nresidual tension ().\nWith a satisfactory an uncomplicated postoperatory period, the drain was removed in 48\nhours and the sutures in 21 days. On the 13th month of ambulatory follow-up,\nthe patient remained without recurrent lesions ().