Reconstruction of Vulva and Perineal Defects After Gynecological Oncological Surgery and Effectiveness of Local Flaps

Abstract

Aim: Although most defects can close by primary suturing after radical surgery of gynecological malignancies, different reconstruction options are available when large defects that require reconstruction occur. In this study, we present the treatment strategy and results for patients who underwent reconstruction after resection for gynecological cancer in the vulva and perineum. Material and Methods: A total of 18 patients who underwent reconstruction between May 2018 and July 2020 were included in this retrospective study. Demographics and clinical data, the resection operation, characteristics of the defect, and the reconstruction methods applied were evaluated. Postoperative treatment strategy and complication rates were evaluated. Results: The mean age was 62.3±13.2 (42-83) years. 88.9% of the patients had additional diseases. Pelvic exentration was performed in 5 (27.8%) patients, anterior resection in 2 (11.1%) patients and vulvectomy in 11 (61.1%) patients. The most common malignancy was squamous cell carcinoma, and mean defect size was 106±97 (12-476) cm 2 . Reconstruction was performed with a local fasciocutaneous flap in 16 (88.9%) patients, pedicled rectus myocutaneous flap in one (5.6%) patient, and skin graft in one (5.6%) patient. Wound complications occurred in 5 (27.8%) patients, partial flap necrosis in one (5.6%) patient, and recurrence in one (5.6%) patient in the long term. Conclusion: It is possible to reconstruction most of the vulva and perineal defects with local flaps after oncological resections, Considering the characteristics of the area and patient comorbidities, it should be kept in mind that prolonged wound problems may be seen, especially in vulvectomy patients.

Perforator versus Non-Perforator Flap-Based Vulvoperineal Reconstruction—A Systematic Review and Meta-Analysis

“…Forty-nine studies fulfilled the selection criteria. Among them, thirty-two studies analyzed non-perforator flaps [ 9 , 10 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], only nine studies focused on perforator flaps [ 21 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], and eight studies focused on both [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ] ( Figure 2 ).…”

“…The 49 studies were conducted in Europe ( n = 29) [ 9 , 10 , 20 , 22 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 47 , 50 , 52 , 54 , 57 , 58 , 62 , 65 ], the United States ( n = 5) [ 29 , 44 , 46 , 48 , 49 ], and Asia ( n = 15) [ 21 , 23 , 32 , 33 , 37 , 51 , 53 , 55 , 56 , 59 , 60 , 61 , 63 , 64 , 66 ] and were published between 1990 and 2022. Two studies were multicentric [ 28 , 50 ]; the others were monocentric.…”

“…Patient satisfaction was analyzed in eight studies [ 21 , 25 , 28 , 32 , 51 , 53 , 58 , 60 ] including only 177 patients (9.6%). These eight studies showed a wide range in the proportion of satisfied patients, ranging from 38% to 100% ( Figure 9 ).…”

“…The low percentage of satisfied patients in the study by Shin et al [ 51 ] and Chang et al [ 21 ] is explained by the fact that only a small proportion of patients reported their level of satisfaction to the study team. Five studies [ 25 , 28 , 44 , 49 , 60 ] from the non-perforator group addressed returning to sexual activity after surgery ( Figure 10 ). Tan et al [ 60 ] also used one perforator flap but did not report on the sexual activity of this patient specifically.…”

“…Muallem 2022 [24] 126 Flap combination (22), local fasciocutaneous flap (84), myocutaneous flap (20) Shin 2022 [51] Local perforator fasciocutaneous flap (27) Zhang 2022 [61] Local fasciocutaneous flap (30), VRAM (2) ALT (2) Aksan 2021 [25] Local fasciocutaneous flap (29), skin graft (1), VRAM (1) Giannini 2021 [26] Local fasciocutaneous flap (40) Tock 2019 [27] Gluteal thigh flap ( 16), local fasciocutaneous flap (45) Fin 2018 [28] Local fasciocutaneous flap (59) Hand 2018 [29] Local fasciocutaneous flap (42) Hellinga 2018 [9] Local fasciocutaneous flap (89) Confalonieri 2017 [10] 365 Local fasciocutaneous flap (365) Gentileschi 2017 [52] ALT (16) Lange 2017 [20] 114 Local fasciocutaneous flap (114) Chang 2016 [21] PAP ( 19) Conri 2016 [30] Local fasciocutaneous flap (36) Herraiz Roda 2016 [31] Local fasciocutaneous flap (17) Huang 2015 [53] Local perforator fasciocutaneous flap (16), PAP (11) Kim 2015 [32] Local fasciocutaneous flap (41) Negosanti 2015 [62] Local fasciocutaneous flap ( 28) DIEP (5) Nomura 2015 [33] Local fasciocutaneous flap ( 16), non-specified flap (3) Zhang 2015 [63] Gracilis myocutaneous flap (1), TRAM (1) ALT (24), DIEP (1) Zhang 2015_2 [64] Gracilis myocutaneous flap (2), TRAM (1) ALT ( 24), DIEP (6), pudendal thigh fasciocutaneous flap (7) Benedetti Panici 2014 [34] Local fasciocutaneous flap (29)…”