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Radical excision of vulval disease and multidisciplinary tissue flap reconstruction: the belfast experience
Mark H McComiskey1, Andrew Robinson, Chris Hoo
1Department of Gynaecology, Belfast City Hospital, Belfast, Northern Ireland. mmccomiskey@doctors.org.uk
Objective:
The aim of this study was to compare Belfast City Hospital's vulval flap reconstructive surgery with recognized standards and published data to facilitate modifications to practice.
Materials And Methods:
Retrospective cohort study involving women who underwent vulval reconstructive skin flap procedures from January 1, 2004, through December 31, 2009.
Results:
A total of 25 women underwent 28 flaps; age range was 41 to 90 years and mean parity was 2.1. Indications for surgery were recurrence of cancer in 11 (44%) of the 25 women, benign disease in 6 women (24.0%), primary vulval cancer in another 6 women (24.0%), and vulval intraepithelial neoplasia in 2 women. Thirteen women (52.0%) within the study had undergone previous radical vulval excision. Wide local excision was performed in 14 women (56.0%), with 5 undergoing radical vulvectomy and 6 undergoing modified radical vulvectomy. There were 15 (53.6%) of the 28 lotus flaps, 6 (21.4%) rhomboid-type repairs, and 3 (10.7%) gracilus flaps.Intensive care unit admission immediately after operation was required in 2 (8.0%) of the 25 women. Return to the operating theater was required in 5 cases (20.0%). Hospital stay ranged from less than 1 week to greater than 6 weeks, the mode being 8 to 14 days and mean being 21.5 days. A total of 16 (64.0%) of the 25 cases experienced wound infection with or without breakdown, with 12 cases (48.0%) having wound infection. There were 10 cases (40.0%) of partial or complete wound breakdown. Necrosis of wound (5 cases) and lymphocyst (2 cases) were less common. Twelve women (48.0%) experienced some form of medical postoperative complication(s), whereas 15 women (60.0%) had no long-term complications.
Conclusions:
The rate of local flap procedure is higher than that published elsewhere, whereas the postoperative complication rate is comparable and adherent to accepted standards. Perioperative protocols have been reported to improve complication rates, and this strategy has been adopted in Belfast.
