Introduction/Background The most effective treatment of vulvar cancer is surgery. The results of treatment are influenced by the volume of tissues removed during the operation. Radial excision of tumors is associated with the formation of extensive wound defects. In most cases, traditional suturing of the wound edges after radical vulvectomy leads to postoperative complications. The use of displaced fascial skin flaps on the pedicle for the closure of wound defects can reduce the number of postoperative complications, improve oncological results and the quality of life of patients.
Methodology A retrospective analysis of the results of surgical treatment of patients with malignant neoplasms of the vulva (n = 202) was carried out. First group (n = 92) included the patients with displaced fascial skin flaps used in covering of perineal wound defect. The second group (2) included patients, with suturing the wound edges (n = 110). The patients in the groups were identical by age (median 68 years old), stage of the disease. Predominant stages were II and III: 35.7% and 33.3% (in the 1st group), 37.3% and 31.8% (in the 2nd group). There were no differences between the groups in number of inguinal-femoral lymphadenectomy. Patients in the 1st group were significantly more likely to undergo surgical interventions with resection of the urethra (23.8% vs 3.1% in the 2nd group), which was associated with the localization of the primary tumor.
The observation time ranged from 2 to 20 years. The analysis of postoperative complications, disease-free and overall survival in each was carried out for the period from 1995 to 2015.
Results Significantly less number of postoperative complications (suppuration, rough healing of postoperative wounds, rough scars, vaginal stenosis) were registered in the 1st group: 4.8% vs 44.6% in the 2nd group. The hospital stay was significantly less: in the 1st group: 18.8 ± 1.4 days vs 26.9 ± 4.6 days in the 2nd group. The recurrence rate in the 1st group was 9.53% vs 24.6% in the 2nd group, which is probably due to wider excision of the perineal tissue using reconstructive plastic surgery. Five-year survival was 76.5% in the 1st vs 56% in the 2nd group.
Conclusion The use of reconstructive plastic surgery for closing of wound defects after radical vulvectomy reduces the incidence of postoperative complications and improves oncological treatment results.
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