Outcome of vulvar reconstruction in patients with advanced and recurrent vulvar malignancies

The use of flaps in vulvar cancer-related reconstruction has been increasing, but few studies have evaluated the outcome and quality of life of patients after this surgery. The purpose of this study was to evaluate the outcomes of vulvar reconstruction using musculocutaneous/skin flaps in patients with advanced and recurrent vulvar malignancies.

Patients with vulvar malignancies who underwent vulvar reconstruction using different types of flaps were retrospectively reviewed. Patient outcomes were evaluated with a focus on quality of life and prognosis.

Thirty-six patients were enrolled, 58.33% of them used anterolateral thigh flap (ALT), 16.67% of them used pudendal thigh flap (PTF), 11.11% of them used deep omferior epigastric perforator (DIEP) and gracilis myocutaneous flap were used in 2.78% of the patients, the other 11.11% patients used two types of flaps. Eleven patients (30.56%) developed complications, including 5 patients (13.89%) with partial necrosis, 5 (13.89%) with minimal wound dehiscence and 1 (2.78%) with flap cellulitis. All patients who developed partial necrosis (13.89%) underwent reoperation. The mean verbal rating scale score was 1.44 before reconstruction and 0.17 after surgery (P < 0.0001). The mean performance status was 1.67 before surgery and improved to 0.31 after surgery (P < 0.0001). The median overall follow-up time after vulvar reconstruction was 9 months. Twenty-one patients (58.3%) developed recurrence at a median interval of 5 months after vulvar reconstruction. After a median follow-up time of 14 months, 41.7 % of the patients were living and disease-free. The 5-year survival of the 36 patients was 53.8%.

Soft tissue reconstruction in patients undergoing resection of advanced/recurrent vulvar malignances is associated with a low rate of postoperative complications, decreased pain, and improved functional status. Although the recurrence rate in this patient population is high, a reasonable proportion of patients who undergo resection for advanced/recurrent vulvar cancer and reconstructive surgery appear to benefit.