Figure 4: (a) Radical vulvo-vaginectomy defect. There was a large dead space in the pelvis. (b) Design of rectus musculocutaneous island flap with and oblique skin design. (c) The flap was tunneled though the pelvis to obliterate the dead space. The skin island resurfaced the skin defect in the vulval region. A perforator based V-Y advancement flap from the medial thigh has also been used to resurface the skin defect. (d) The flaps on 5th postoperative day.