Secondary healing strategy for difficult wound closure in invasive vulvar cancer: a pilot case-control study

Abstract

OBJECTIVES: Despite the number of surgical advances and innovations in techniques over time, radical vulvectomy frequently results in substantial loss of tissue that cannot be primarily closed without tension, the mobilization of surrounding tissues or even the rotation of myocutaneous flaps. The aim of this study was to evaluate the feasibility of leaving the surgical vulvar open wound for secondary healing in situations where primary closure of the vulvar wound is not possible. METHODS: This case-control pilot study analyzed 16 women with a diagnosis of squamous cell carcinoma of the vulva who first underwent inguinofemoral lymphadenectomy, 6-week sessions of chemotherapy and 25 daily sessions of radiotherapy. Afterward, excision of the vulvar lesion with free margins was performed between January 2011 and July 2017. Twelve patients underwent primary closure of the wound (control), and in 4 patients, the surgical wound was left open for secondary healing by means of a hydrofiber (case). The inclusion criteria were a) FIGO-2009 stage II up to IIIC; b) squamous cell carcinoma; and c) no evidence of pelvic or extrapelvic disease or pelvic nodal involvement. The exclusion criteria were extrapelvic disease or pelvic nodal involvement, another primary cancer, or a poor clinical condition. ClinicalTrials.gov: NCT02067052. RESULTS: The mean age of the patients at the time of the intervention was 62.1. The distribution of the stages was as follows: II, n=6 (37 %); IIIA, n=1 (6%), IIIB, n=1 (6%) and IIIC, n=8 (51%). The mean operative time was 45 minutes. The hospital stay duration was 2 days. Full vulvar healing occurred after an average of 30 days in the control group and after an average of 50 days in the case group. CONCLUSION: A secondary healing strategy may be an option for the treatment of vulvar cancer in situations of non-extensive surgical wounds when primary closure of the wound is not possible.

Reconstruction of Vulva and Perineal Defects After Gynecological Oncological Surgery and Effectiveness of Local Flaps

“…Local fasciocutaneous flaps are usually the first choice of many surgeons in the absence of extensive tissue deficiency (2,7). Successful results have even been reported by leaving primary non-closable defects to secondary healing (11). The blood circulation of the perineal area, gluteal region and medial part of the thigh is provided by a rich perforator vascular system.…”

“…Obesity in the reconstruction of vulva and perineum defects; emerges as another disadvantage. Increased body mass index and obesity are important negative factors in the development of wound complications (11,17). In our study, body mass index was 34.8±3.5 (32.2-39.0) kg/m 2 in patients with wound complications; determination of body mass index as 26.5±1.7 (24.1-30.1) kg/m 2 in patients without wound complications supports these findings.…”

<p>Success of ¹²⁵I-Seed Treatment in Vulvar Squamous-Cell Carcinoma with Aplastic Anemia: A Case Report</p>

“…Surgical treatment is usually the first choice for patients with earlystage vulvar SCC, including radical vulvectomy with bilateral inguinofemoral lymphadenectomy as a treatment of choice for vulvar SCC; 19 however, the substantial loss of tissue involved in such surgery results in a risk of postoperative complications. 20 After consultation with several hospitals, it was concluded that surgery and chemotherapy would be intolerable for our patient, because of her history of AA. In this case, radiotherapy was the only option.…”

Cold Atmospheric Pressure Plasma (CAP) as a New Tool for the Management of Vulva Cancer and Vulvar Premalignant Lesions in Gynaecological Oncology

“…Evidence also suggests the beneficial role of CAP in the acceleration of healing different wounds without side-effects (i.e., premalignant lesions). As a result, CAP is an appropriate clinical approach for the treatment of wounds after surgical intervention, mostly for minimizing prolonged wound healing, which is associated with a poor prognosis due to delayed adjuvant therapy [198].…”