Recommendations are graded as per the Royal College of Obstetricians and Gynaecologists document. Clinical Governance Advice No. 1: Guidance for the Development of RCOG Green-top Guidelines, available on the RCOG website at: 

British Gynaecological Cancer Society (BGCS) Vulval Cancer Guidelines: An Update on Recommendations for Practice 2023

Introduction Surgical treatment is the gold standard of care for vulvar cancer and is burdened by a high risk of wound complications due to the poor healing typical of the female genital area. Moreover, this malignancy has a high risk of local relapse even after wide excision. For these reasons, secondary reconstruction of the vulvoperineal area is a relevant and challenging scenario for gynecologists and plastic surgeons. The presence of tissue already operated on and undermined, scars, incisions, the possibility of previous radiation therapy, contamination of urinary and fecal pathogens in the dehiscent wound or ulcerated tumor, and the unavailability of some flaps employed during the primary procedure are typical complexities of this surgery. Due to the rarity of this tumor, a rational approach to secondary reconstruction has never been proposed in the literature. Methods In this observational retrospective study, we reviewed the clinical data of patients affected by vulvar cancer who underwent secondary reconstruction of the vulvoperineal area in our hospital between 2013 and 2023. Oncological, reconstructive, demographic, and complication data were recorded. The primary outcome measure was the incidence of wound complications. The secondary outcome measure was the indication of the different flaps, according to the defect, to establish an algorithm for decision-making. Results Sixty-six patients were included; mean age was 71.3 ± 9.4 years, and the mean BMI was 25.1 ± 4.9. The mean size of the defect repaired by secondary vulvar reconstruction was 178 cm2 ± 163 cm2. Vertical rectus abdominis myocutaneous (VRAM), anterolateral thigh (ALT), fasciocutaneous V-Y (VY), and deep inferior epigastric perforator (DIEP) were the flaps more frequently employed. We observed five cases of wound breakdown, one case of marginal necrosis of an ALT flap, and three cases of wound infection. The algorithm we developed considered the geometry and size of the defect and the flaps still available after previous surgery. Discussion A systematic approach to secondary vulvar reconstruction can provide good surgical results with a low rate of complications. The geometry of the defect and the use of both traditional and perforator flaps should guide the choice of the reconstructive technique.

/pdf/secondary-post-oncologic-vulvar-reconstruction-a-simplified-c5oi2rzt.pdf

Secondary post-oncologic vulvar reconstruction – a simplified algorithm

Background/Aim: Vulva cancer surgery is associated with a high level of morbidity mostly due to wound healing disorders in the inguinal region following lymphadenectomy. Our aim is to evaluate the feasibility of negative pressure wound therapy (NPWT) using the PICO™ device in groin wounds after lymphadenectomy. Patients and Methods: The groins of twenty patients who underwent bilateral lymph node dissection were dressed with the PICO™ device. All patients were followed prospectively with clinical controls up to three months postoperatively using a standardized study protocol. Results: A total of 11 patients (55%) developed a surgical site complication (SSC). One patient suffered from a wound rupture two days after surgery, six a lymphocele and four a surgical site infection. Operation time, blood loss, number of lymph nodes removed, length of hospital-stay and duration of PICO™ treatment did not differ between women with and without SSCs. Conclusion: NPWT using the PICO™ device seems to be a feasible method to reduce the severity of healing disorders in the groin after lymphadenectomy in vulva cancer patients.

/pdf/negative-pressure-wound-therapy-npwt-in-groin-wounds-after-4nvlknds1e.pdf

Negative Pressure Wound Therapy (NPWT) in Groin Wounds After Lymphadenectomy in Vulvar Cancer Patients.

Surgical evaluation of inguinal lymph nodes is essential to correctly guide the adjuvant treatment of vulvar cancer patients. Open inguinal lymphadenectomy (OIL) approach is the preferred route, while the videoendoscopic inguinal lymphadenectomy (VEIL) seems to be associated with better results. This meta-analysis aimed to compare the surgical outcomes of OIL vs VEIL in vulvar cancer. 

Surgical outcomes and morbidity in open and videoendoscopic inguinal lymphadenectomy in vulvar cancer: a systematic review and metanalysis”

Do groin drains reduce postoperative morbidity in women undergoing inguino-femoral lymphadenectomy for vulvar cancer?

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Do groin drains reduce postoperative morbidity in women undergoing inguino-femoral lymphadenectomy for vulvar cancer?