A Review of Reconstruction for Vulvar Cancer Surgery

Abstract

Importance Vulvar reconstruction may be required after vulvectomy or any vulvar surgery. Providers should be familiar with techniques for reconstruction to improve clinical outcomes. Objective This article reviews the different techniques for reconstruction after vulvectomy and describes the decision-making process for selection of appropriate techniques, postoperative care, and expected outcomes. Evidence Acquisition A literature search was conducted, focusing on the plastic surgery and gynecologic oncology literature, using the following search terms: “vulvar reconstruction,” “perineal reconstruction,” “vulvectomy,” and “vulvar cancer.” The search was limited to English publications. Results Reconstruction after vulvectomy can be performed using a variety of techniques ranging from simple or complex closure to adjacent tissue rearrangement to skin grafting, locoregional, and free flaps. The appropriate technique is best chosen based on the characteristics of the patient and postablative defect, as well as the reconstructive goals. Postoperative complications are usually minor. Conclusions Vulvar reconstruction techniques vary widely and offer patients improved outcomes. Relevance Knowledge of vulvar reconstruction techniques is necessary for gynecologists performing vulvar surgery to ensure optimal patient outcomes. Target Audience Obstetricians and gynecologists, Family Physicians Learning Objectives After completing this activity, the learner should be better able to describe 3 different techniques of vulvar reconstruction; explain the factors involved in choosing a technique; and identify possible complications of vulvar reconstruction.

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience

“…Plastic vulva restoration is essential, especially in cases of total vulvectomy, to restore the woman’s sense of physical wholeness. Reconstructive surgery can preserve the patient’s self-esteem and sense of femininity when conducted to restore both the vulvar architecture and function [ 4 , 5 , 6 , 7 ].…”

Sub‐regional skin grafting for perineal resurfacing after excision of superficial vulvar tumors: An excellent method to achieve an aesthetically pleasing appearance

“…Although the form and function of the vulva cannot be fully restored after lesion removal, surgical techniques could markedly improve the vulvar appearance 1 . The aim of vulvar reconstruction is to create two skin folds with adequate size, sagittal symmetry and a suitable vaginal orifice without disturbing micturition and defecation 2 . In comparison to the normal disease‐free state, the achievable reconstructive results of adjacent flaps, pedicle skin flaps, and free skin flaps are fairly crude 3 .…”

“…1 The aim of vulvar reconstruction is to create two skin folds with adequate size, sagittal symmetry and a suitable vaginal orifice without disturbing micturition and defecation. 2 In comparison to the normal disease-free state, the achievable reconstructive results of adjacent flaps, pedicle skin flaps, and free skin flaps are fairly crude. 3 One commonly used method for reconstructing skin-only defects is nonmeshed skin grafting.…”

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

“…Several previous reports introduced the selection methods for vulvar reconstruction after wide vulvar excision. 6,[11][12][13][14] However, the selection of algorithm methods was also complicated. Therefore, simplifying the algorithm using recently reported simple and low-complication surgical methods is needed.…”

“…Several previous reports introduced the selection methods for vulvar reconstruction after wide vulvar excision 6,11–14 . However, the selection of algorithm methods was also complicated.…”