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Abstract
Introduction/Background Total vulvectomy is associated with high morbidity due to the frequency of healing complications. Skin flap plasty has improved management but there is a risk of necrosis, flap collapse and infection, hence the interest in hyperbaric oxygen therapy (HBOT) as an adjuvant treatment for these complications.
Methodology We compare the efficacy of HBOT on vulvectomy healing in two 60-year-old patients who underwent radical total vulvectomies in our department, the first for high-grade squamous intraepithelial lesions and the second for stage Ib squamous cell carcinoma of the vulva.
Results Regarding the first patient, after failure of conservative treatments, a total vulvar resection surgery with immediate plasty by skin flaps was performed. After a first complication by superficial necrosis of the flaps, HBOT allowed firstly to improve the survival of the compromised grafts and to stop the extent of the necrosis, and secondly to improve and accelerate the healing after total resection of the necrotic areas. She received 13 daily HBOT at a pressure of 2.5 atm for 90 minutes per treatment. Concerning the second patient, a radical vulvectomy with healthy resection margins and bilateral inguinal curage returned negative. Her radiotherapy was delayed and a repeat surgery concluded to a vulvar recurrence. A postoperative oxygen therapy of 26 sessions did not allow to obtain healing and the patient died at two months with local recurrence and pulmonary metastasis.
Conclusion Hyperbaric oxygen therapy has proven its effectiveness as an adjuvant treatment for complications of vulvar surgery. Information on its use is limited in the literature and further studies are needed to properly codify its use in gynecologic surgery.