Reconstrucción vulvoperineal con colgajos locales / Vulvoperineal reconstruction with local fl aps

Luego del tratamiento quirúrgico de la patología maligna y premaligna de la región vulvoperineal nosenfrentamos al desafío de la reconstrucción del defecto de cobertura, el cual en la mayoría de los casos no puede resolverse con un cierre primario. Se presentan 2 casos de reconstrucción con colgajos locales con el objetivo de reparar el defecto, ofrecer un tejido vascularizado, el cual aporta mayor oxigenación, migración celular y un buen resultado estético ­ funcional. La reparación se realizó con colgajos de trasposición dependientes de la arteria pudenda y colgajos de avance y rotación del lado contralateral. Hemos concluido que la confección de colgajos locales en la región vulvar para la reconstrucción de defectos es una opción a tener en cuenta debido al aporte vascular, la presencia de perforantes dependientes de la arteria pudenda, la conservación nerviosa, el bajo índice de morbilidad y el aceptable resultado estético ­ funcional.

After the surgical treatment of the malignant and premalignant pathology of the vulvoperineal region we have the challenge of reconstruction the coverage defect, which in most cases cannot be resolved with a primary closure. We describe 2 cases of reconstruction with local fl aps, the aim is to repairing the defect, off ering a vascularized tissue, which provides more oxygenation, cell migration and a good aesthetic-functional result. The repair was performed with transposition fl aps dependent on the pudendal artery and advance and rotation fl aps of the contralateral side. We concluded that the repairwith local fl aps in the vulvar region for the reconstruction of defects is an option to take into account due to the vascular contribution, the presence of perforators dependent on the pudendal artery, nerve conservation, low morbidity index and acceptable aesthetic result - functional.

Reconstrucción vulvoperineal en cáncer vulvar / Vulvoperineal reconstruction in vulvar cancer

Resumen ANTECEDENTES: Los estadios clínicos avanzados del cáncer vulvar representan un reto quirúrgico y un abordaje que requiere ser multidisciplinario, con cirugía plástica que provea márgenes quirúrgicos adecuados, con menor tasa de complicaciones, cierre primario de la herida e inicio temprano de la terapia oncológica coadyuvante. OBJETIVOS: Describir y exponer las alternativas de reconstrucción vulvoperineal para pacientes con cáncer vulvar, atendidas en el Instituto Nacional de Cancerología de México. MATERIALES Y MÉTODOS: Análisis descriptivo y retrospectivo de casos de pacientes a quienes se hizo reconstrucción vulvoperineal en el Instituto Nacional de Cancerología, México, entre enero y diciembre de 2015, por el mismo cirujano plástico. Se muestra el algoritmo basado en su experiencia. RESULTADOS: Se analizaron 11 casos de pacientes operadas con diferentes técnicas de reconstrucción vulvoperineal, por defectos quirúrgicos del cáncer vulvar y se expuso el algoritmo utilizado y la experiencia del cirujano. CONCLUSIONES: Se revisaron las diferentes alternativas de reconstrucción para subsanar defectos quirúrgicos en pacientes con cáncer vulvar. Los algoritmos de tratamiento quirúrgico previamente publicados son confusos y complejos, quizá por la baja incidencia del cáncer vulvar y las diversas opciones de procedimientos de reconstrucción.

Abstract BACKGROUND: Vulvar cancer is a relatively infrequent disease, that constitutes 1-5% of all gynecological cancers. Surgery is the mainstay treatment is adequate resection, and lymph node evaluation, often have a high risk of relapse that may reach 65%. ADVANCED: Stages are a surgical challenge and multidisciplinary ap proach with plastic surgery will provide adequate surgical margins, less complications, adequate wound closure, and early adjuvant treat ment starting; as well as excellent cosmetic results, with functional, psychological and sexual morbidity decreased. OBJECTIVES: To describe and present the alternatives of vulvoperineal reconstruction in vulvar cancer at Instituto Nacional de Cancerología, Mexico. METHODS: A retrospective descriptive analysis of eleven cases of vulvoperineal reconstruction in vulvar cancer was performed from January 2015 to December 2015, at Instituto Nacional de Cancerología, Mexico; for one plastic surgeon; and demonstrated the algorithm base don their experience. RESULTS: We performed 11 patients of vulvar reconstruction with different reconstructive techniques, such as gracilis flapping, pudend, with a high success rate. as well as, to propose an algorithm based in our experience with vulvar cancer reconstruction at Instituto Nacional de Cancerología, Mexico. CONCLUSION: The present article aims to review the reconstructive alternatives in Vulvar Cancer, several algorithms for surgical treatment have been published before; but they tend to be complex, in part be cause of the low incidence of Vulvar Cancer and the several options of reconstructive procedures.

Surgical therapy of vulvar cancer: how to choose the correct reconstruction? / 부인종양

OBJECTIVE: To create a comprehensive algorithmic approach to reconstruction after vulvar cancer ablative surgery, which includes both traditional and perforator flaps, evaluating anatomical subunits and shape of the defect. METHODS: We retrospectively reviewed 80 cases of reconstruction after vulvar cancer ablative surgery, performed between June 2006 and January 2016, transferring 101 flaps. We registered the possibility to achieve the complete wound closure, even in presence of very complex defects, and the postoperative complications. On the basis of these experience, analyzing the choices made and considering the complications, we developed an algorithm to help with the selection of the flap in vulvoperineal reconstruction after oncologic ablative surgery for vulvar cancer. RESULTS: We employed eight types of different flaps, including 54 traditional fasciocutaneous V-Y flaps, 23 rectus abdominis myocutaneous flaps, 11 anterolateral thigh flaps, three V-Y gracilis myocutaneous flaps, three free style perforators V-Y flaps from the inner thigh, two Limberg flaps, two lotus flaps, two deep inferior epigastric artery perforator flap, and one superficial circumflex iliac artery perforator flap. The structures most frequently involved in resection were vulva, perineum, mons pubis, groins, vagina, urethra and, more rarely, rectum, bladder, and lower abdominal wall. CONCLUSION: The algorithm we implemented can be a useful tool to help flap selection. The key points in the decision-making process are: anatomical subunits to be covered, overall shape and symmetry of the defect and some patient features such as skin laxity or previous radiotherapy. Perforator flaps, when feasible, must be considered standard in vulvoperineal reconstruction, although in some cases traditional flaps remain the best choice.

Reconstruction of Congenital Absence of Vagina using Vulvoperineal Fasciocutaneous Flap: A Case Report

PURPOSE: Congenital absence of the vagina is a rare case. It occurs as a result of Mullerian duct aplasia or complete androgen insensitivity syndrome. The reconstructive modality includes skin graft, use of intestine and various methods of flap. We report a patient who underwent vulvoperineal fasciocutaneous flap to reconstruct congenital absence of the vagina, while the external genitalia and ovaries are normal. METHODS: A 26-year-old woman presented with vaginal agenesis. Under general anesthesia, a U-shaped incision was made between the urethral meatus and the anus. The new vaginal pocket was created up to the level of the peritoneal reflection between the urinary structures and the rectum. Next, the vulvoperineal fasciocutaneous flaps were designed in a rectangular fashion. Flap elevation was begun at the lateral margin which the adductor longus fascia was incised and elevated, and the superficial perineal neurovascular pedicle was invested by the fascial layer. The medial border was then elevated. A subcutaneous tunnel was created beneath the inferior of the labia to rotate the flaps. The left vulvoperineal flap was rotated counterclockwise and the right was rotated clockwise. The neovaginal pouch was formed by approximating the medial and lateral borders. The tubed neovagina was then transposed into the cavity. RESULTS: In 3 weeks, the vaginal canal remained supple After 6 weeks, the physical examination showed normal-appearing labia majora and perineum with an adequate vaginal depth. A year after the operation, the patient had a 7 cm vagina of sufficient width with no evidence of contractures nor fibrous scar formation. The patient was sexually active without difficulty. CONCLUSION: Although many methods were described for reconstruction of vaginal absence, there is not a method yet to be approved as a perfect solution. We used the vulvoperineal fasciocutaneous flap to reconstruct a neovagina. This method had a following merits: a single-stage procedure, excellent flap reliability, the potential for normal function, minimal donor site morbidity and no need for subsequent dilatation, stents, or obturators. We thought that this operation has a good anatomic and functional results for reconstruction of the vagina.

Carcinoma epidermoide en condilomatosis vulvoperineal gigante / Epidermoid carcinoma in giant vulvoperineal condilomatosis

La condilomatosis vulvoperineal es una entidad muy frecuente en mujeres en edad reproductiva; recomendándose realizar la tipificación del virus papiloma humano, dada la relación de algunos subtipos con el carcinoma epidermoide a nivel ginecológico. Se presenta el caso de una paciente femenina de 39 años que consultó por presentar una lesión exofítica, verrugosa que ocupa labios mayores y menores de la vulva, clítoris, introito vaginal y región perianal; de la cual se toma biopsia incisional reportando papilomatosis por virus papiloma humano, sin evidencia de atipias. Se lleva a quirófano realizando dermovulvectomía, cuya biopsia definitiva reportó carcinoma epidermoide invasor bien diferenciado, focal, con bordes resección libres; se completa con disección inguinal bilateral superficial y profunda sin evidencia de lesión metastásica ganglionar. Se realizó tipificación viral por reacción de cadena de polimerasa resultando VPH 16. A 20 meses de seguimiento, no hay evidencia clínica ni citológica de lesión recurrente. Es importante realizar la tipificación viral de estas lesiones por su relación con el carcinoma epidermoide de la vulva. Se realizó una revisión de la literatura.

The vulvoperineal condylomatosis it’s a very frequent disease in reproductive age young women; it’s recommended to realize the viral typification, because the relation between some human papillomavirus subtypes with gynaecology epidermoid cancer. We present the case of a 39 years old female patient who consulted to present a exofitic injury, warty that occupies the majora and minora labia of the vulva, clitoris, vaginal vestibule and perianal region; from which incisional biopsy was taken, reporting papilomatosis by human papillomavirus, without evidence of atypias. Patient went to operating room to receive a dermovulvectomy, whose definitive biopsy reported invasive epidermoid carcinoma well differentiated, focal, with free resection margins; it is completed with superficial and deep bilateral inguinal dissection without evidence of metastasic nodal involment. Viral tipificación by reaction of polymerase chain reaction was made being VPH 16. To 20 months of fall up, there are not clinical or cytological evidence of recurrent lesions. It is important to make the viral tipificación of these lesions by its relation with the epidermoid carcinoma of the vulva. A revision of literature was made.

A case report: A case of fibroepithelial polyp on vulvoperineal area / 대한산부인과학회지

A case of fibroepithelial polyp on vulvoperineal area is described. Her age is 20 year old and the tumor measured 9 cm in its largest diameter and was connected to the left labium majus. This case is very unusual in that almost all reported vulvar fibroepithelial polyps are small and sessile, and should distinguish from malignant cancer. We have experienced an unusually large vulvoperineal mass that was surgically excised and histologically diagnosed as benign fibroepithelial polyp and present this case with a brief review of literature.