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Repair of the Perineal Defect After Radical Vulvar Surgery: Direct Closure Versus Skin Flaps Reconstruction
Author(s) -
Landoni Fabio,
Proserpio Maria,
Maneo Andrea,
Cormio Gennaro,
Zanetta Gerardo,
Milani Rodolfo
Publication year - 1995
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1995.tb01987.x
Subject(s) - medicine , surgery , reconstructive surgery , radical vulvectomy , vulvectomy , introitus , urinary incontinence , vulvar cancer , vulva , vagina
EDITORIAL COMMENT: We accepted this paper for publication to remind readers that the trend towards more humanitarian surgical treatment of gynaecological (including breast) carcinoma also applies to cancer of the vulva. A recent editorial in this Journal summarized the modern, less radical, principles of excisional surgery for malignant lesions of the vulva. This paper describes improvements in functional results that can be achieved by skin flaps reconstruction versus the traditional method of direct closure of the wound when radical excisional surgery is required in women with carcinoma of the vulva. Summary: From 1987 to 1990, 72 consecutive patients with primary untreated vulvar cancer underwent radical vulvar surgery with skin flaps reconstruction of the perineal defect. Postoperative complications, anatomical and functional results of this group of patients were compared with those of an historical control group of 77 patients submitted, at the same institution, to radical vulvectomy without reconstructive procedure from 1982 through 1986. The time of operation was significantly longer (180 minutes ± 15 versus 120 minutes ± 20) (p = 0.05) for patients submitted to the reconstructive procedure, while there was no statistically significant difference in intraoperative blood loss and hospital stay between the 2 groups. In comparison with direct closure, reconstructive procedures resulted in a significant lower rate of wound dehiscences (26% versus 64%) (p = 0.0001), vaginal introitus stenosis (2 versus 8) (p = 0.0001), sexual dysfunction (10% versus 50%) (p = 0.0001) and misdirection of the urinary stream (1 versus 5) (p = 0.001). It was concluded that skin flaps reconstruction is simple, reduces postoperative morbidity, and provides better anatomical and functional results than direct closure of the perineal defect.