Radical vulvectomy by two different surgical incisions

To determine the outcome of radical vulvectomy by two different surgical incisions (butterfly vs triple incision) for the treatment of vulval carcinoma.

A comparative study was conducted from January 1992 to July 2003 at Military Hospital Rawalpindi and Fauji Foundation Hospital Rawalpindi. A total of 35 patients were included in this study. One patient received supportive therapy at stage IVB. Out of 34 patients, 23 (67.64%) underwent radical vulvectomy by butterfly incision and 11 (32.35%) radical vulvectomy by triple incision technique. Data regarding history, clinical examination, surgical procedures, per-operative complications, post-operative complications, hospital stay, recurrence and mortality was collected and analyzed.

The percentages of partial wound dehiscence (86.36% vs. 18.18% p = 0.00), wound induration (100% Vs 72.7%, p = 0.008), infection (22.72% vs: 9.09%, p = 0.637) and lymphoedema (9.0% vs. Zero, p = 0.542) were higher in butterfly incision group as compared to triple incision group respectively. The per-operative blood loss (750 +/- 36.9 ml vs. 381 +/- 14.7 ml, p-value: < 0.01), operative time (136.91 +/- 14.73 min Vs 81.82 +/- 14.71 min, p = 0.00) and hospital stay (19.05 +/- 3.27 days Vs 9.09 +/- 0.7 days, p = 0.00) were significantly higher in butterfly incision as compared to triple incision respectively. The recurrence rate in butterfly incision was comparable to triple incision group (14.28% vs. 18.18%, p = 0.572). In the butterfly group one patient died per-operatively and another patient died within one year after surgery.

Radical vulvectomy by triple incision has comparable recurrence rate but significantly less mortality and morbidity rates when compared to butterfly incision.