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Abstract
Introduction/Background The removal of substantial vulvar tumors often requires radical vulvectomy, resulting in extensive defects of vulvar tissue. Flap reconstruction is performed to prevent tension in the surgical wound. Postoperative complications (20–60%) such as dehiscence, infection, necrosis and reintervention are frequent.
There are expensive or complex methods to assess flap viability. Indocyanine green (ICG) may be a cost-effective and efficient tool for evaluating the vitality of vulvar flaps.
This study aims to intraoperatively assess the perfusion of flaps in vulvar cancer reconstructive surgery, using ICG Fluorescence Angiography.
Methodology This single-center, ambispective study included patients with vulvar cancer who required surgical treatment and subsequent vulvar flap reconstructive surgery.
When the reconstructive surgery finished, 25 mg of indocyanine green were intravenously injected, followed by the evaluation of the proper perfusion of the vulvar flap using a fluorescence camera.
Results Ten patients undergoing vulvar reconstructive surgery with flap procedures were included from September 2020 to September 2023. Median age was 77 years.
Primary vulvar surgery was performed in 50% of the patients, while the other 50% underwent recurrent surgeries. 40% of the patients had received previous radiotherapy. The average tumor size was 40 mm. 50% of the performed flaps were VYadvancement flaps.There were no reported intraoperative complications or side effects associated with the ICG. Flap vascularization was evaluated 5–10 minutes after the injection by ICG imaging. In three flaps a low perfusion area was identified and removed. 90% experienced minor dehiscence at the flap level. Two patients developed mild surgical site infections.
Conclusion Intraoperative ICG imaging is a feasible method that allows an accurate assessment of the flap vascularization in vulvar reconstruction as well as the identification and removal of a low vascular perfusion area to avoid postoperative complications. Future studies with larger samples are required to further evaluate the possibilities of this technique in vulvar reconstruction.
Disclosures The authors have no financial interest to declare in relation to the content of this abstract.
