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471 Vulvar and perineal surgery : does flap repair defect strategy allow to balance free margin and post-operative morbidity?
  1. M Andrault1,
  2. N Kerfant2,
  3. C Rebahi3,
  4. P Merviel3,
  5. A Trimaille2 and
  6. PF Dupre1
  1. 1CHRU Brest France, Breast and Gynaecological Oncology, Brest, France
  2. 2CHRU Brest, Plastic, Reconstructive and Aesthetic Surgery, Brest, France
  3. 3CHRU Brest France, Gynaecology, Obstetric and Reproductive Medicine, Brest, France


Introduction/Background*Vulvar and perineal (VP) surgery has to combine surgical efficiency with free margin in an mechanical strained anatomical area with high vulnerability to infectious disease.

The size of excision as well as the anatomical restitution strategy justifies simple or complex associated reconstruction techniques..

Methodology All women who underwent VP surgery from November 2014 to August 2020 in our institution were included.

The cohort was divided into 3 groups : Groupe 0 (G0) : no reconstruction, Groupe 1 (G1) : fasciocutaneous flap, Groupe 3 (G3) pediculed or perforator flap.

Main objective was the margin status specified as follow : Safe Margins (SM) ≥ 8mm, Free Margins (FM) < 8mm and Involved Margins (IM).

Secondary objective were tumor and excision size, and postoperative morbidity.

Data was extract from Excel™ database. Quantitative variables were analyzed using the Chi-square test of Pearson.

Result(s)*Twenty-nine consecutive patients (29) were enrolled in the survey : 72,9% invasive disease (main pathological subtype Squamous Cell Carcinoma).

Twelve patients had a radical vulvectomy (41,4%) and 10 superficial vulvectomy (34,5%).

In group 1, V-Y flap was the most used flap (50%), Lotus Flap in group 2 (58,3%). The others flaps were DIEP, Gracilis, Taylor and rotative flap.

Twelve patients achieved SM (41%), 9 patients SM (31%) without any significant difference between the 3 groups (p= 0.68).

Among the 8 patients with IM (27%), 6 presented with Paget disease, no patient presented with invasive disease and IM in Group 2.

Median size of tumor was similar between the groups (2,5cm vs. 2,8cm, p = 0,76, but excision size seems to be superior in the group 2 (9,5cm vs 6.6cm, p = 0,09).

Clavien Dindo Grade 3 complications occurred in 11 cases (37,9%) and grade 2 in 5 cases (17,2%) without significant difference between G1 and G2.

Main complication was wound dehiscence (48,3%) and 3 patients had partial flap necrosis.

Conclusion*Vulvar and perineal surgery should include the use of a wide range of surgical repair options from local flap to complex reconstruction techniques in order to offer the best compromise between quality of the margins and postoperative morbidity.

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