Personalized reconstructive and plastic approach in the surgical treatment of vulvar cancer

Introduction. The choice of a rational method of treatment in vulvar cancer is one of the most actual and difficult problems of modern clinical oncology. In the majority of cases vulvar cancer occurs in elderly and senile patients, as well as in some patients with locally advanced form. The aim of the investigation was to assess the possibility of reconstruction after surgical treatment of vulvar cancer.Materials and Methods. A study was conducted involving 151 patients with squamous cell vulvar cancer in whom the gynecological oncology department of Chelyabinsk regional clinical center of oncology and nuclear medicine performed surgical treatment by various methods in the following volume: dilated vulvectomy with the resection of adjacent anatomical structures with reconstructive and plastic component.Results. The original ways of plasty of the postoperative wound after vulvectomy were evaluated, the minimum risk of complications was revealed. The presented technologies permit to use additional variants of the wound defect reconstruction and have a number of advantages in comparison with two dermalfascial flaps from the medial surfaces of the femur used earlier. Discussion. Studies have shown that vulvar reconstruction using skin flaps can avoid complications and improve patients' quality of life. Reconstruction with flaps is not currently an accepted standard of treatment for vulvar cancer. Conclusion. The methods of the wound defect closure are possible after radical vulvectomy in patients with squamous cell vulvar cancer and resection of adjacent anatomical structures without reduction of surgical treatment volume. These methods of wound defect closure contribute to the reduction of postoperative complications and significantly reduce postoperative stay in a medical institution.

The Pedicled Deep Inferior Epigastric Perforator (DIEP) Flap for Vulva Reconstruction

Pain, scar contracture and soft tissue defects are common late sequel of acne inversa and Fournier’s gangrene. Aesthetical as well as functional reconstruction of the external vulva and labia majora can be very challenging. We present two cases where a pedicled Deep Inferior Epigastric Perforator (DIEP) flap for vulva reconstruction was implemented. In order to reconstruct both labia majora, we partially split the flap and raised a bilaterally pedicled DIEP flap. Many local flap techniques have been published on vulvar reconstruction. The aim of this paper is a discussion of the present literature and a review of current strategies for soft tissue restoration with the DIEP flap for vulva reconstruction. Wepresent and discuss two cases which were successfully reconstructed using the described surgical technique

Tạo hình khuyết hổng trong phẫu thuật ung thư âm hộ: báo cáo 2 trường hợp tạo hình phức tạp và tổng quan y văn

Performing radical surgery for locally advanced vulvar cancer is usually associated with the occurrence of large perineal defects. These defects, especially in previously radiated cases, often require more advanced reconstructive techniques using locoregional flaps. We present two cases of vulvar reconstruction, one case using a split and thinned, transversely oriented, pedicled deep inferior epigastric artery perforator (DIEP) flap and another one with gracilis myocutaneous flap. These pedicled flap seems to be an effective and feasible method of perineal reconstruction after extended perineal resection for locally advanced vulvar cancers. especially in pre-irradiated patients.