Secondary post-oncologic vulvar reconstruction - a simplified algorithm.

Area of Science:

• Gynecologic Oncology
• Plastic and Reconstructive Surgery

Background:

• Vulvar cancer surgery has high complication rates due to poor wound healing in the genital area.
• Local relapse is common even after wide excision, necessitating complex secondary reconstructions.
• Previous surgeries, radiation, and contamination complicate vulvar reconstruction.

Purpose of the Study:

• To propose a rational approach for secondary vulvar reconstruction.
• To evaluate the outcomes and complication rates of secondary vulvar reconstruction.
• To develop a decision-making algorithm for flap selection in secondary vulvar reconstruction.

Main Methods:

• Retrospective observational study of 66 patients undergoing secondary vulvar reconstruction (2013-2023).
• Data collected included oncological, reconstructive, demographic, and complication details.
• Flap selection was guided by defect geometry and availability, leading to an algorithm.

Main Results:

• Mean defect size was 178 cm²; common flaps included VRAM, ALT, VY, and DIEP.
• Low complication rates observed: 5 wound breakdowns, 1 marginal flap necrosis, 3 wound infections.
• The developed algorithm considered defect characteristics and prior surgical history.

Conclusions:

• A systematic approach to secondary vulvar reconstruction yields favorable outcomes.
• Flap choice should be guided by defect geometry and the availability of traditional and perforator flaps.
• This strategy can minimize complications in challenging vulvar reconstructions.