Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap.

Abstract

Simple SummaryInguinal lymphadenectomy for vulvar cancer is often followed by secondary lower limb lymphedema. This significant treatment-related morbidity cannot be healed and worsens over time, causing symptoms significantly affecting the patients’ quality of life and creating disability, economic burden for physical therapies, infections and reduction of presence and performance at work. This study aimed to reveal the incidence and severity of lower limb lymphedema in patients who have undergone inguinal lymphadenectomy and immediate groin reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap. In our series of patients, a significant protective effect of the lymphatic SCIP flap-based immediate reconstruction of the inguinal area emerged, and our results suggest that this easy and quick technique can reduce the incidence and severity of secondary lower limb lymphedema after groin dissection for vulvar cancer.Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs’ volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student’s t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL.