Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

Abstract

ObjectiveTo create a comprehensive algorithmic approach to reconstruction after vulvar cancer ablative surgery, which includes both traditional and perforator flaps, evaluating anatomical subunits and shape of the defect.MethodsWe retrospectively reviewed 80 cases of reconstruction after vulvar cancer ablative surgery, performed between June 2006 and January 2016, transferring 101 flaps. We registered the possibility to achieve the complete wound closure, even in presence of very complex defects, and the postoperative complications. On the basis of these experience, analyzing the choices made and considering the complications, we developed an algorithm to help with the selection of the flap in vulvoperineal reconstruction after oncologic ablative surgery for vulvar cancer.ResultsWe employed eight types of different flaps, including 54 traditional fasciocutaneous V-Y flaps, 23 rectus abdominis myocutaneous flaps, 11 anterolateral thigh flaps, three V-Y gracilis myocutaneous flaps, three free style perforators V-Y flaps from the inner thigh, two Limberg flaps, two lotus flaps, two deep inferior epigastric artery perforator flap, and one superficial circumflex iliac artery perforator flap. The structures most frequently involved in resection were vulva, perineum, mons pubis, groins, vagina, urethra and, more rarely, rectum, bladder, and lower abdominal wall.ConclusionThe algorithm we implemented can be a useful tool to help flap selection. The key points in the decision-making process are: anatomical subunits to be covered, overall shape and symmetry of the defect and some patient features such as skin laxity or previous radiotherapy. Perforator flaps, when feasible, must be considered standard in vulvoperineal reconstruction, although in some cases traditional flaps remain the best choice.

Fusion of ultrasound and 3D single‐photon‐emission computed tomography/computed tomography to identify sentinel lymph nodes in vulvar cancer: feasibility study

“…Median overall time to perform fusion imaging was 32 (range, [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] min. Median duration of Step 1 (acquisition of 3D volumes and target identification on CT and SPECT) was 10 (range, 8-12) min; of Step 2 (coregistration and synchronization of SPECT/CT and ultrasound) was 10 (range, 7-10) min; and of Step 3 (fine tuning and SPECT/CT and ultrasound fusion imaging navigation) was 12 (range, [8][9][10][11][12][13][14][15][16][17][18][19] min. Time spent performing Steps 1 and 2 was similar in all 10 cases, whereas the time spent performing Step 3 reduced significantly from the first to the last examination (19 vs 12 min; Figure 4).…”

Simultaneous correction of breast hypertrophy and vaginal agenesis: Aesthetic surgery to the aid of reconstructive surgery

“…Mayer‐Rokitansky‐Kuster‐Hauser syndrome is a complex of developmental defects characterized by the complete or partial agenesis of the vagina and uterus associated with normal external genitalia and gonads . Different non‐surgical and surgical techniques are available to treat this anomaly . Primary vaginal elongation by dilation is recommended as first‐line approach in most patients .…”

“…1 Different non-surgical and surgical techniques are available to treat this anomaly. 15 Primary vaginal elongation by dilation is recommended as first-line approach in most patients. 6 Anyway, patients must be very well prepared to this approach because dilation may require longer than 1 year to achieve anatomic or functional success and notwithstanding different protocols of dilation, patients should be encouraged to dilate as frequently as they can, within the constraints of their daily schedule.…”

Experience with gluteal V‐Y fasciocutaneous advancement flaps in vulvar reconstruction after oncological resection and a modification to the marking: Playing with tension lines

“…The choice of reconstructive method after vulvectomy depends on various factors, some of which are linked to the size and type of defect or the individual characteristics of the patient, while others are associated with the flap. Local fasciocutaneous flaps are generally the first choice of many surgeons, except in cases of widespread tissue destruction, for example, in the dissection of several lymph nodes or pelvic exenteration, when muscle flaps are preferred because of their greater mass . Indeed, the perineal area, buttocks, and medial portion of the thigh are supplied by a rich system of perforator vessels, mainly branches of the internal pudendal and deep femoral arteries but also the inferior gluteal artery, upon which to base local fasciocutaneous flaps (perforator or not) of various shapes and sizes .…”