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1204 Medial thigh fasciocutaneous flap and indocyanine green angiography for reconstructive surgery in vulvar cancer
  1. Beatriz Sánchez-Hoyo,
  2. Aureli Torné,
  3. Ariel Glickman,
  4. Tiermes Marina,
  5. Núria Carreras,
  6. Cristina Celada,
  7. Pere Fusté and
  8. Berta Díaz-Feijóo
  1. Hospital Clínic of Barcelona, Barcelona, Spain

Abstract

Introduction/Background Surgery is considered the mainstay of treatment in early stages of vulvar cancer and in association with radio-chemotherapy for advanced disease. Despite surgical treatment provides good local control of the disease, it often entails significant functional and anatomical impairment, affecting sexual function, body image perception and global quality of life.

Advances in reconstructive techniques enables an improvement in functional and aesthetic results, guarantees an adequate coverage of larger tumors and assures safe surgical margin. In addition, intraoperative indocyanine green (ICG) angiography is acquiring interest as a useful tool in flap-based surgeries, revealing perfusion defects than can be correct intraoperatively.

Methodology We report the case of a 78-year-old woman with an HPV-independent squamous cell carcinoma of the vulva (FIGO staging 2021 II), managed in our gynecological oncology unit in collaboration with plastic surgeons. A radical vulvectomy, adding the clitoral area, was performed to enable a complete exeresis of the malignant lesion with adequate surgical margins. Unilateral medial thigh fasciocutaneous advancement flap was the reconstructive technique performed, and intraoperative ICG angiography was also used to analyze flap perfusion and correct flap edges.

Results In Figure 1 are represented some steps during the surgery. After complete tumor resection, flap preparation and placement over the genitalia defect, flap perfusion was evaluated using intraoperative ICG angiography. A distal perfusion defect in the upper-inner edge was detected and correct by removing the distal 2 cm.

Conclusion Plastic reconstructive techniques added to vulvar cancer surgery offers the opportunity to amplify surgical treatment to larger tumors while optimizing functional and anatomic results. Intraoperative ICG angiography can improve these reconstructive surgery results by guiding the surgeon in early detection and correction of potential vascular defects.

Disclosures Authors have no conflict of interest to declare.

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