• Vulva
• Surgical Flaps
• Surgical Procedures, Operative
• Vulvar Diseases

Vulvar cancer accounts for approximately 5% of all gynecological cancers. Squamous cell carcinomas make up 95% of all vulvar cancers. The vast majority of squamous cell carcinomas affect predominantly elderly women.1

A patient was referred for multidisciplinary care as her chief complaint was post-menopausal bleeding, vaginal discomfort, and a bulky vaginal mass. She had a history of dyslipidemia, hypertension, diabetes mellitus type 2, osteoporosis, and Crohn’s disease. At physical examination a vulvar lesion of approximately 8 cm was seen in the left labia majora. A vulvar biopsy was undertaken which showed squamous cell carcinoma with necrosis and poorly differentiated areas. The vulvar cancer was International Federation of Gynecology and Obstetrics stage III.2 A chest, abdominal and pelvic CT scan found no pulmonary lesions but a left inguinal adenopathy of 9.7 mm. A partial radical vulvectomy with V–Y advancement flap reconstruction and unilateral inguinofemoral lymphadenectomy was made. 3 The histopathology report was undifferentiated neoplasm with metastasis proximal to the clitoris, tumor with free margins and four ganglia positive for metastasis from a total of nine.

Surgery is the primary treatment for vulvar cancer. Vulvar tumors should be removed with a radical local excision with the aim of obtaining histological tumor-free margins. The type of reconstruction is based on patient/tumor characteristics and experience of the surgical team. Currently, the repair methods reported include skin grafts, fasciocutaneous flaps, and myocutaneous flaps. The primary objectives of vulvar defect reconstruction are closure without any tension, less scarring of the perineum, and suturing of the donor area in a single stage. For treating a major defect of the labia majora, the literature recommends repair of the vulva and thigh root with a V–Y advancement flap. This involves mobilizing the adjacent skin and underlying subcutaneous tissue to cover the primary defect. 4 Vulvar reconstruction is critical for cosmetic, functional, and psychological reasons. Additionally, post-operative intercourse is crucial, especially in this type of surgery due to the high risk of complications, which can be reduced with proper surgical techniques.