Successful Use of Myocutaneous Flap in Recurrent Vulvar Carcinoma: A Case Report

Abstract

Vulvar cancer being a rare gynecological malignancy, many dilemmas and controversies remain during management of such cases. Radical surgeries are associated with severe postoperative morbidity due to wound-related complications increasing the hospital stay and delaying adjuvant therapies. A case is discussed where wound complications were prevented with the use of flaps. A 58-year-old postmenopausal lady presented with itching in the vulva and a large ulcerative growth on the right side of the vulva. Biopsy from lesion diagnosed to be moderately differentiated squamous cell carcinoma. Triple incision modified radical vulvectomy with bilateral inguinofemoral lymphadenectomy with sartorius transposition was done. There were no postoperative complications. Histopathology showed keratinizing squamous cell carcinoma vulva grade 2, with a tumor-free margin of 7.8 mm, and single lymph node metastasis of ≥ 5 mm. She was advised adjuvant radiotherapy but did not follow up. Five months later, she presented again with an ulcerative lesion in the right groin. It was diagnosed to be skin bridge recurrence. She was managed with wide excision with a reconstruction of the groin wound with vertical rectus abdominis myocutaneous (VRAM) flap. The grafted wound and the donor site both healed well without any complications.. The patient was referred for adjuvant radiotherapy. Histopathology confirmed it to be skin bridge recurrence. Skin bridge recurrences are rare and occur in modified radical vulvectomies with separate groin incisions. Surgical excision of recurrences leaves large wounds that need reconstructive surgeries for management. VRAM flap is a very versatile flap which can be used for reconstruction in genital malignancies.