Surgery For Vulvar Cancer Research Articles

Reconstruction methods in vulvar cancer: a narrative review

Background : Vulvar cancer is a rare type of cancer that accounts for 1% of all cancers in women and about 3-8% of all gynecological cancers in the world. Although resection of the lesion is the first choice for treatment, reconstructive methods of the vulva have been increasingly used recently. Flaps are most commonly used for this purpose. However, it is important to remember that the reconstruction must be adjusted to the patient's needs, taking into account the geometry of the wound, as well as potential secondary complications.Aim of the study: The aim of this study is to present the different methods of plastic surgery for vulvar cancer, which included V-Y, VRAM, ALT, DIEP and lotus flaps. The following article focuses on describing the above methods, presenting their advantages and disadvantages, in which cases they can be used, and potential complications.Material and methods: The literature review was conducted in the PubMed database. The inclusion criteria used in the review included compliance with topic, publication date after 2015 and English language. Articles of low credibility, duplicated, not in English language and with abstracts unrelated to the topic were excluded. Results: Of the articles found, 32 studies were eventually to be reviewed. The research shows that the choice of reconstruction method can be difficult, while there is no single correct approach in vulvar cancer cases.Conclusions: In summary, the interdisciplinary collaboration between the gynecologist oncologist, the surgeon and the radiotherapist, plays a key role in the treatment process.

Prevalence of prescribing topical corticosteroids to patients with lichen sclerosus following surgery for vulvar cancer: a survey among gynaecologic oncologists in The Netherlands

Background Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcinoma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC). Methods An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed. Results Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p < 0.001). If treatment was initiated, ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups. The most reported reason for treating patients in both groups with TCS was symptoms, followed by clinical aspects of the lesion and prevention of progression to dVIN and VSCC. Conclusion The majority of GOs who participated in our study endorse the utilisation of long-term ultra-potent TCS therapy in both patients with LSnoVSCC and LSVSCC. Nevertheless, Dutch GOs are currently prescribing TCS more frequently to patients with LSnoVSCC than to patients with LSVSCC.

Vulvar cancer management and wrangling recurrent disease: A report from the society of gynecologic oncology journal club

The Society of Gynecologic Oncology (SGO) Journal Club webinar series is an open forum that invites national experts to discuss the literature pertaining to important topics in the management of gynecologic cancers. On August 14th, 2023, SGO hosted a journal club focused on the management of upfront and recurrent vulvar cancer. Our discussants included Dr. Brian M Slomovitz from Mount Sinai Medical Center in Miami Beach, Dr. Emi Yoshida from the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, and Dr. Lilian Gien from the University of Toronto Sunnybrook Odette Cancer Center. During the discussion,we reviewed the progression of vulvar cancer surgery from en bloc resection of the vulva and groins, to partial radical vulvectomy and sentinel lymph nodes. We also reviewed the management of node positive vulvar cancer including published and accruing Groningen International Study on Sentinel Nodes in Vulvar Cancer (GROINSS) trials and other sentinel trials from the Gynecologic Oncology Group (GOG). Here we will also review the literature on the management of recurrent vulvar cancer, highlighting current treatment options and ongoing clinical trials. The following is a report of the journal club presentation.

Peri-operative factors affecting wound complication following vulvar cancer surgery (1164)

Peri-operative factors affecting wound complication following vulvar cancer surgery (1164)

Overall survival associated with surgery, radiotherapy, and chemotherapy in metastatic vulvar cancer: A retrospective cohort study based on the SEER database

BackgroundLarge cancer registries help analyze the prognosis of rare malignancies, such as advanced vulvar cancer. This study aimed to compare the overall survival (OS) rates of patients with metastatic vulvar cancer who had undergone chemoradiotherapy and radiotherapy alone and identify prognostic factors using data from the Surveillance, Epidemiology, and End Results (SEER) registry. MethodsIn this retrospective cohort study, we used the SEER database to identify patients with metastatic vulvar cancer diagnosed between 2000 and 2019. Propensity score matching was performed to balance the covariates. Kaplan–Meier curves and Cox models were used to analyze OS. ResultsA total of 685 patients were included and divided into chemoradiotherapy and radiotherapy groups, and 400 patients were included after propensity score matching. The chemoradiotherapy group had higher OS in the matched cohort (hazard ratio [HR] = 0.7367; 95% confidence interval [CI]: 0.5906–0.9190; P = 0.0049) than the radiotherapy group, which was similar to that in the pre-matched cohort (P < 0.0001). Patients who had undergone surgery + radiotherapy with or without chemotherapy showed higher OS rates than those who had received radiotherapy with or without chemotherapy for patients aged <75 years and local tumor excision/destruction or surgical removal of the primary site was the recommended surgical choice (P < 0.05). Chemoradiotherapy is sufficient for patients ≥75 years of age. ConclusionsPatients with metastatic vulvar cancer should undergo surgery if they can tolerate it. Adjuvant chemoradiotherapy should be encouraged because this treatment modality was associated with higher OS than radiotherapy alone.

Temporal trends of failure-to-rescue following perioperative complications in vulvar cancer surgery in the United States

ObjectiveFailure-to-rescue, defined as mortality following a perioperative complication, is a perioperative quality indicator studied in various surgeries, but not in vulvar cancer surgery. The objective of this study was to assess failure-to-rescue in patients undergoing surgical therapy for vulvar cancer. MethodsThis cross-section study queried the National Inpatient Sample. The study population was 31,077 patients who had surgical therapy for vulvar cancer from 1/2001–9/2015. The main outcomes were (i) perioperative morbidity (29 indicators) and (ii) mortality following a perioperative complication during the index admission for vulvar surgery (failure-to-rescue), assessed with a multivariable binary logistic regression model. ResultsThe cohort-level median age was 69 years, and 14,337 (46.1%) had medical comorbidity. Perioperative complications were reported in 4736 (15.2%) patients during the hospital admission for vulvar surgery. In multivariable analysis, patient factors including older age, medical comorbidity, and morbid obesity, and treatment factors with prior radiotherapy and radical vulvectomy were associated with perioperative complications (P < 0.05). The number of patients with morbid obesity, higher comorbidity index, and prior radiotherapy increased over time (P-trends < 0.001). Among 4736 patients who developed perioperative complications, 55 patients died during the hospital admission for vulvar surgery (failure-to-rescue rate, 1.2%). In multivariable analysis, cardiac arrest (adjusted-odds ratio [aOR] 27.25), sepsis or systemic inflammatory response syndrome (aOR 11.54), pneumonia (aOR 6.03), shock (aOR 4.37), and respiratory failure (aOR 3.10) were associated with failure-to-rescue (high-risk morbidities). There was an increasing trend of high-risk morbidities from 2.0% to 3.7% over time, but the failure-to-rescue from high-risk morbidities decreased from 9.1% to 2.8% (P-trend < 0.05). ConclusionVulvar cancer patients undergoing surgical treatment had increased comorbidity over time with an increase in high-risk complications. However, failure-to-rescue rate has decreased significantly.

Association between Preoperative Psychiatric Morbidities and Mortality after Oncologic Surgery: A Nationwide Cohort Study from 2002 to 2019 in South Korea.

We aimed to examine whether preoperative psychiatric morbidities affect 30-day postoperative mortality. Using a nationwide registration database in South Korea, the study included all patients who underwent curative cancer surgery from 1 January 2002 to 31 December 2019. Patients underwent surgery for breast, laryngeal, lung, thyroid, gastric, colorectal, esophageal, liver, pancreatic, kidney, bladder, testicular, prostate, vulvar, uterine, or brain cancer. Depression, anxiety disorder, substance abuse, and post-traumatic stress disorder were considered preoperative psychiatric morbidities. Among the 944,794 patients in the final analysis, 5490 (0.6%) died within 30 days of the surgery, and 24,370 (2.6%) had preoperative psychiatric morbidities. Multivariable logistic regression analysis showed that preoperative psychiatric morbidities were associated with a higher (adjusted odds ratio [aOR]: 1.23; 95% confidence interval [CI]: 1.09, 1.39; p = 0.001) 30-day mortality rate than the rate noted for patients without preoperative psychiatric morbidities. This association was significant in the breast (aOR: 3.31, 95% CI: 1.36, 8.07; p = 0.009), lung (aOR: 1.54, 95% CI: 1.19, 2.01; p = 0.001), and kidney (aOR: 1.87, 95% CI: 1.06, 3.31; p = 0.03) cancer groups in the subgroup analyses. In South Korea, preoperative psychiatric morbidities are considered to be associated with increased 30-day postoperative mortality.

Nursing of Vulvar Cancer Radical Operation Combined with Laparoscopic Inguinal Lymph Node Dissection.

Purpose The application, development, and care of radical surgery combined with laparoscopic inguinal lymph node dissection for vulvar cancer. Methods We searched the PubMed, Web of Science, the Cochrane Library, and EMBASE databases for published literature on the care of radical surgery combined with laparoscopic inguinal lymph node dissection for vulvar cancer up to June 2022. We used the following search terms and terms: “vulvar cancer,” “injury,” “radical vulvar cancer surgery,” “laparoscopic inguinal lymph node dissection,” and “care.” Results Laparoscopic inguinal lymph node dissection has become a new surgical method for the treatment of vulvar cancer, and it effectively avoids all the problems associated with traditional surgery. In addition, radical vulvar cancer surgery and laparoscopic inguinal lymph node dissection combined with high-quality nursing interventions can promote patients' recovery and reduce the occurrence of complications, which has important clinical significance. Conclusion This article reviews the application, development, and nursing care of radical vulvar cancer surgery combined with laparoscopic inguinal lymph node dissection.

EP42.05: VITA consensus opinion and vulvar cancer surgery: histological correlation and its influence on survival

EP42.05: VITA consensus opinion and vulvar cancer surgery: histological correlation and its influence on survival

Paradigm shift from lymphadenectomy to sentinel lymph node biopsy in vulvar cancer surgery (364)

<b>Objectives:</b> To examine trends, characteristics, and outcomes related to nodal assessment for vulvar cancer surgery in the United States. <b>Methods:</b> This is a retrospective observational cohort study querying the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population was 5,604 women with T1b or T2-smaller (<4cm) squamous cell carcinoma of the vulva who underwent primary vulvectomy from 2003-2018. Exposure allocation was based on nodal evaluation type, including lymphadenectomy (LND; <i>n</i>=3,319, 59.2%), sentinel lymph node (SLN) biopsy (<i>n</i>=751, 13.4%), or no surgical nodal evaluation (<i>n</i>=1,534, 27.4%). The main outcomes were <i>1)</i> trends and characteristics related to SLN biopsy assessed by the multinomial regression model, and <i>2)</i> vulvar cancer-specific survival assessed by comparing risk analysis and propensity score weighting. The sensitivity analysis included evaluation of the external cohort with T1a disease (<i>n</i>=1,291). Fig. 1 <b>Results:</b> The utilization of SLN biopsy increased from 5.7% to 23.3% in 2006-2018, while the proportion of LND decreased from 64.1% to 48.8% in 2010-2018 (p<0.05) (top panel). These associations remained independent in multivariable analysis: SLN biopsy use in 2015-2018 versus 2003-2006, with an adjusted-odds ratio of 3.57 (95% CI: 2.54-5.01, p<0.001), and LND use in 2015-2018 versus 2003-2006, with an adjusted-odds ratio of 0.79 (95% CI: 0.63-0.97, p=0.027). In a propensity score weighted model, 5-year cumulative rate for vulvar cancer-specific mortality was 15.2% (interquartile range: 12.1-18.9) for the SLN biopsy group and 16.9% (interquartile range 15.6-18.3) for the LND group (subdistribution-HR [sHR]: 0.90, 95% CI: 0.76-1.06, p=0.217) (bottom panel). Similar association was also observed in T1b disease (sHR: 0.88, 95% CI: 0.70-1.09, p=0.236), T2-smaller (<4cm) disease (sHR: 0.82, 95% CI: 0.50-1.33. p=0.419), and N0 cases (sHR: 0.93, 95% CI: 0.70-1.22, p=0.594). Increasing performance of SLN biopsy was also observed in T1a disease from 1.3% to 7.3% during the study period (p<0.001). <b>Conclusions:</b> The landscape of surgical nodal evaluation is shifting from lymphadenectomy to SLN biopsy in vulvar cancer surgery. This study suggests that an SLN biopsy-incorporated treatment approach is not associated with worse survival compared to LND.

Ten years of live surgical broadcast at Charité-MAYO conferences (2010–2019): a systematic evaluation of the surgical outcome

ObjectiveThe international Charité-MAYO Conference aims to promote international dialog on diagnostics, management, scientific breakthroughs, and state-of-the-art surgical procedures in gynecology and gynecologic oncology and senology. Live surgeries are a fundamental...

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience.

Simple SummaryWhen it comes to advanced vulval cancer management, there is a critical quandary to consider. This is owing to the severe negative impact of demolitive surgery on women who are afflicted by both functional and psychological consequences of the procedure. Primary closure of vulvar and/or perineal defects can be accomplished without difficulty in many situations, but this is accompanied by tension of the skin closure and distortion of the anatomy. In these circumstances, reconstructive surgery will be required to restore the anatomical and functional characteristics of the vulva. In this paper, we share our substantial expertise of primary closure versus reconstruction after demolitive surgery of advanced vulvar cancer, and we discuss our findings in light of the literature.(1) Background: plastic reconstruction in vulvar surgery can lead to a better treatment outcome than primary closure. This study aims to compare the preoperative parameters (co-morbidities and tumor size) and postoperative results (tumor free margins and wound healing) between the primary closure and reconstructive surgery after vulvar cancer surgery; (2) Methods: this is a retrospective analysis of prospectively collected data from 2009 to 2021 at a tertiary cancer institution; (3) Results: 177 patients were included in the final analysis (51 patients had primary closure PC and 126 had reconstructive surgery RS). About half (49%) of the PC patients had no co-morbidities (p = 0.043). The RS group had a 45 mm median maximal tumor diameter compared to the PC group’s 23 mm (p = 0.013). More than 90% of RS and 80% of PC had tumor-free margins (p = 0.1). Both groups had anterior vulvar excision as the most common surgery (52.4% RS vs. 23.5% PC; p = 0.001). Both groups had identical rates of wound healing disorders. In a median follow-up of 39 months; recurrent disease was found in 23.5% of PC vs. 10.3% in RS (p = 0.012). In terms of overall survival there was no significant difference between the both groups; (4) Conclusions: reconstructive vulvar surgery enables enhanced complete resection rates of larger vulvar tumors with better anatomical restoration and a comparable wound recovery in comparison to primary closure. This results in a lower recurrence rate despite the increased tumor volume.

Impact of vulvar reconstruction on the accuracy of a nomogram for predicting local recurrence after surgery for vulvar cancer

Summary background dataVulvar carcinoma is a rare disease accounting for 3%–5% of all gynaecological cancers. Although surgery is the standard treatment at an early stage, the outcomes are highly correlated with clear resection margins. Therefore, surgical defects can be important and require reconstruction. The aim of this study was to evaluate vulvar reconstructions using a previously validated nomogram predicting the risk of local recurrence at 2 years. MethodsPatients who underwent surgery for vulvar cancer between 1998 and 2017 were extracted from eight FRANCOGYN centres. We estimated the probability of local recurrence at 2 years using a previously validated nomogram and compared it with actual relapse in patients with or without vulvar reconstruction. Patients were clustered into tiertiles according to their nomogram score: low-, intermediate-, and high-risk for local relapse probability. ResultsWe reviewed 254 patients, of whom 49 underwent immediate vulvar reconstruction. The predicted and actual probability of two-year local relapse were 20.1% and 15.7%, respectively, with a concordance index of 0.75. In the low- and intermediate-risk groups, the difference between predicted and observed recurrence was less than 10% in patients with or without vulvar reconstruction. For the high-risk group, the difference reached 25% and observed recurrence probability was lower in patients who underwent vulvar plasty compared with those who did not (20.0% vs. 36.2%, respectively). Local recurrence-free survival rates following vulvar reconstruction were comparable at two years (82.1% vs. 84.8%, respectively, p = 0.26). ConclusionVulvar reconstruction after surgical resection for vulvar cancer is safe. Vulvar reconstruction should be considered in aggressive cases to decrease local recurrence.

Complications and risk factors in vulvar cancer surgery – A population-based study

IntroductionPrimary surgery for vulvar cancer has become less radical in past decades. This study investigates risk factors and prevalence of short-and long-term complications after up-to-date vulvar cancer surgery. MethodsPopulation-based cohort study of surgically treated primary vulvar cancer at a national center of vulvar cancer, assessing surgical outcome. The Swedish Quality Registry for Gynecological Cancer was used for identification, journals reviewed and surgical outcome including complications within 30 days and one year registered. Multivariable logistic regression analysis comprising risk factors of short-term complications; age>80 years, BMI, smoking, diabetes, lichen sclerosus and FIGO stage was performed. Results182 patients were identified, whereas 55 had vulvar surgery only, 53 surgery including sentinel lymph node biopsy (SLNB) and 72 surgery including inguinofemoral lymphadenectomy (IFL), with short-term complication rates of 21.8%, 39.6% and 54.2% respectively. Vulvar wound dehiscence was reported in 6.0% and infection in 13.7%. Complication rates were lower after SLNB than IFL (wound dehiscence 0% vs 8.3%; p = 0.04, infection 15.1% vs 36.1%; p = 0.01 and lymphocele 5.7% vs 9.7%; p = 0.52). Severe complications were rare. Persisting lymphedema evolved in 3.8% after SLNB and in 38.6% after IFL (p = 0.001), ubiquitous after adjuvant radiotherapy. In multivariable regression analysis, no associations between included risk factors and complications were found. ConclusionSurgical complications are still common in vulvar cancer surgery and increase with the extent of groin surgery. To thrive for early diagnosis and to avoid IFL seem to be the most important factors in minimizing short-and long-term complications.

Population-level trends and outcomes of sentinel lymph node biopsy in vulvar cancer surgery in the United States

ObjectiveTo examine population-level trends, characteristics, and outcomes related to nodal assessment for vulvar cancer surgery in the United States. MethodsThis is a retrospective cohort study querying the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population was 5604 women with T1b or T2-smaller(≤4 cm) squamous cell carcinoma of the vulva who underwent primary vulvectomy from 2003 to 2018. The exposure allocation was based on nodal evaluation type: lymphadenectomy (LND; n = 3319, 59.2%), sentinel lymph node (SLN) biopsy (n = 751, 13.4%), or no surgical nodal evaluation (n = 1534, 27.4%). The main outcomes were (i) trends and characteristics related to SLN biopsy assessed by multinomial regression model, and (ii) vulvar cancer-specific survival assessed by competing risk analysis and inverse probability of treatment weighting propensity score. Sensitivity analysis included evaluation of external cohort with T1a disease (n = 1291). ResultsThe utilization of SLN biopsy increased from 5.7% to 23.3% in 2006–2018, while the proportion of LND decreased from 64.1% to 48.8% in 2010–2018, and these associations remained independent in multivariable analysis (adjusted-P < 0.05). In the propensity score weighted model, 5-year cumulative rate for vulvar cancer-specific mortality was 15.2% (interquartile range 12.1–18.9) for the SLN biopsy group and 16.9% (interquartile range 15.6–18.3) for the LND group (subdistribution-hazard ratio 0.90, 95% confidence interval 0.76–1.06, P = 0.217). The increasing SLN biopsy use was also observed in T1a disease from 1.3% to 7.3% during the study period (P < 0.001). ConclusionThe landscape of surgical nodal evaluation is shifting from lymphadenectomy to SLN biopsy in vulvar cancer surgery in the United States. SLN biopsy-incorporated treatment approach was not associated with worse survival compared to LND.

Radical vulvectomy with right gluteal and left medial thigh V-Y advancement flap reconstruction

Vulvar cancer is rare. The vulva constitutes the external female genitalia and it is associated with the perineum with the intersection of urinary, sexual and anal systems. The deep anatomy of the perineum in the urogenital and anogenital triangle should be well-known to gynecological oncologists. Radical vulvectomy is the surgical treatment of choice in gross tumors expanding over the vulvar skin. After this type of excision, reconstruction is critically important because it is not always feasible to suture the vulvar defect in a primary manner. Thus, the reconstruction options should also be known to gynecological oncologists. Here, we present a video of radical vulvar cancer surgery, which was performed on a cadaver with gluteal and medial thigh V-Y advancement flap reconstruction.

Impact of Vulvar Cancer Surgery on Quality of Sex Life: A Review of Literature.

Vulvar cancer is a gynecological cancer for which posttreatment morbidity must be known to propose the appropriate medical strategy. The objectives of this article were to review and to summarize the available studies evaluating the impact of vulvar surgery on the quality of sex life. We searched MEDLINE abstracts (source PubMed) and included all studies published between 1990 and 2020 that evaluated the impact of vulvar surgery on the patients' sex life. Articles were selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We evaluated the quality of the studies using the "study quality assessment tools" established by the National Heart Lung and Blood Institute and the health-related quality-of-life score. Summary statistics were used to report the results of the studies selected. A total of 41 articles were screened, and 15 studies were included in this review. Two questionnaires, that is, European Organization for Research and Treatment of Cancer QLC C30 and Female Sexual Function Index, were used in 60% of the studies. The quality of the studies was heterogeneous. None of them had a high level of evidence. Eleven of the 16 studies reported an impairment of quality of sex life, mainly related to the size of the initial lesion and the type of surgery performed. Preoperative sexual status, that is, active sex life, age, and morbidity seemed to be important factors. None of the studies had a high level of evidence, and their methodological quality was heterogeneous. More powerful studies using validated questionnaires are necessary. Because this is essential surgery, patients should be informed that if it impacts their sexual life, management strategies will be part of their postoperative care.

Reconstruction of pelvic exenteration and gynecologic tumor defects: a pictorial essay for a systematic method

Background: Reconstruction of the defects created by extirpative surgery or radiation for gynecologic cancer can be challenging for both patients and surgeons. In the subset of patients who present with recurrent gynecologic cancer after previously successful treatment and radiation therapy, wounds to irradiated tissue are difficult to heal, requiring a collaborative effort between the gynecologic oncologists and the plastic and reconstructive surgeons. Other factors that may hinder successful repair include comorbidities, history of radiation, ongoing tobacco use, and overall protein malnutrition. To maximize repair success, decrease recurrence, and optimize aesthetic outcome, gynecologic oncologists and plastic and reconstructive surgeons need to communicate the anticipated anatomic and physiologic obstacles to each other and to the patient. Purpose: To create a systematic approach from our current method of gynecologic oncologic reconstruction that facilitates communication among general surgeons, gynecologic oncologists, and plastic and reconstructive surgeons to optimize gynecologic oncologic reconstructive and aesthetic outcomes while minimizing wound complications. Methods: A retrospective chart review was conducted on patients who underwent gynecologic oncologic surgery for vulvar, vaginal, cervical, and uterine cancer over a 10-year period. A step-by-step method and categorization for gynecologic reconstruction was generated from our experience, and a pictorial essay was created to demonstrate this method and highlight the most common complications. Results: The pictorial essay serves as a template for gynecologic oncology or plastic and reconstructive surgeons to follow and effectively close gynecologic tumor defects and facilitate patient care. The most common complications were seroma and distal skin necrosis, managed by early excision and closure without consequence. Satisfaction with surgical outcomes was high among the patients. Conclusion: Successful repair of primary and recurrent gynecologic tumors requires communication between the gynecologic oncologist and the plastic and reconstructive surgeon. The procedures are challenging and require resilience from both the patient and the surgeons. Incision placement is important for adequate flap reconstruction to prevent wound and skin breakdown. Wound breakdown is likely and requires preoperative counseling. High protein nutritional stores are important for expeditious healing.

Feasibility, indications and complications of SCIP flap for reconstruction after extirpative surgery for vulvar cancer

Surgical therapy for vulvar cancer involves wide defects that often require flap-based reconstruction. The goal of the reconstruction is fast wound healing with low donor site morbidity. This is a retrospective observational cohort study in which we reviewed all patients who underwent surgery for vulvar cancer followed by reconstruction using the Superficial Circumflex Iliac Artery Perforator (SCIP) flap between 2015 and 2020. The primary outcome measure of this investigation was the incidence of wound complications. The secondary outcomes were the surgical indications in terms of establishing the anatomical subunits involved in the resection that made us choose this flap for reconstruction. This study adheres to the STROBE guidelines. Thirty-two patients were included; in two cases, the flap was performed bilaterally for a total of 34 SCIP flaps. The mean age of patients was 70.6±8.6 years, and the mean BMI was 26.8±4.7. The SCIP flap was always feasible. The mean flap size was 128.8±74.3cm2. Three patients showed wound complications. In every patient, the defect involved the vulva, perineum and inguinal area; in 18 patients, the mons pubis was also involved. The mean follow-up was 30 months. During the follow-up, six patients died, and four showed local or nodal cancer relapse. Our results suggest that the advantages of SCIP flap for the reconstruction of vulvoperineal defects secondary to vulvar cancer surgery include low complication rate, minimal donor site morbidity, quick dissection, proximity of donor and recipient sites, possibility to harvest large skin islands of variable thickness and chimeric flaps.

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial