Subcutaneous Vulvar Flap Viability Evaluation With Near-Infrared Probe and Indocyanine Green for Vulvar Cancer Reconstructive Surgery: A Feasible Technique

Abstract

Introduction: Vulvar cancer is a rare condition affecting older women and accounts for 3–5% of all gynecological cancers. Primary surgical treatment involves the removal of a large amount of tissue for which reconstructive surgery is often necessary with a high rate of postoperative complications. Despite several techniques for the evaluation of vulvar flap viability have been proposed, many methods cannot be performed during surgery and require expensive devices often missing in a gynecological clinic. This study aims to verify the feasibility and the safety of the vulvar flap viability evaluation through a near-infrared endoscopic probe and Indocyanine green (ICG) tracer in a small group of patients and to evaluate long-term vulvar flap outcomes.Methods: Patients with primary vulvar cancer who required surgical treatment and subsequent vulvar flap reconstructive surgery were prospectively included in the study. A 25 mg ICG vial diluted in 20 ml of saline solution was intravenously infused before closing the skin edges of the flaps. All patients were given 0.2 mg/kg body weight of intravenous ICG. After 10–15 min, a near-infrared endoscopic probe was used to evaluate the vulvar flap viability.Results: Of the 18 patients who underwent radical vulvectomy for vulvar cancer during the study period, 15 were included in the analysis. All packaged surgical flaps showed tracer uptake on the surgical margin. No intro-operative complications were recorded neither surgery-related nor to dye infusion. No surgical infection, dehiscence, or necrosis was recorded.Conclusions: Vulvar flap viability assessment using Indocyanine green and a laparoscopic infrared probe is a feasible method. All cases included in the analysis showed a dye uptake on the surgical edge of the flap. Further, prospective studies are needed to confirm the method in clinical practice and to evaluate its superiority over simple subjective clinical evaluation.

A Comprehensive Discussion in Vaginal Cancer Based on Mechanisms, Treatments, Risk Factors and Prevention

“…In the initial stages of vulvar, only surgery is considered as the backbone of treatment, whereas in advanced stages, surgery is combined with chemotherapy or radiation (128)(129)(130). Surgical intervention ensures adequate local control, but it comes with anatomical or functional limitations that compromise quality of life and sexual function.…”

“…With V-Y fasciocutaneous flap repair, Hand et al found 33 and 15% surgical dehiscence and infection, respectively (138). The vitality of the restored tissue following its displacement is an important factor in vulvar flap success (128). Some points about reconstructive surgery.…”

Analysis of Short-Term Efficacy of Gasless Single-Port Laparoscopic Inguinal Lymphadenectomy Through Vulva Incision for Vulvar Cancer

“…Compared to VEIL-H, it can be a safe surgical approach with more minimally invasion. For those with a larger scope of vulvar excision, the reconstructive techniques of the perineum after radical surgery, alongside VEIL-V, could increase the quality of life of these patients ( 20 , 21 ). Since the choice of incision is located 2 cm from the outer edge of the tumor, this surgical method is not suitable for tumors close to the perineal union, which will cause inconvenience in operation.…”

Management of Vulvovaginal Cellular Angiofibroma: A Single-Center Experience

“…Additionally, regarding wether reconstructive surgery should be performed. Generally, for vulvar caner, surgeons always aim for surgical margins of 2 cm to achieve pathological margins of at least 8 mm to minimize local disease recurrence, removing a large amount of tissue ( 11 ).In these circumstances, reconstructive surgery is often necessary, after radical wide local excision of tumor or radical vulvectomy, to reduce the risk of postoperative complication ( 12 – 15 ). Female cellular angiofibroma predominantly occurs in the superficial soft tissues of the vulva ( 2 ).…”