Insights from plastic and reconstructive surgery wound specialists in managing complex vaginal and vulvar toxicities...

Radiation therapy is essential for treating vaginal and vulvar cancers but can cause chronic pain, sexual dysfunction, infections, and delayed wound healing. These complications profoundly impact survivors' quality of life and may impede cancer-directed treatment in recurrent disease. We describe a multidisciplinary approach involving Plastic and Reconstructive Surgery, Gynecologic Oncology, and Radiation Oncology for managing complex radiation-induced wounds.

We retrospectively reviewed two patients with severe vaginal/vulvar radiation wounds treated at a tertiary wound care center.

Case 1: A 71-year-old woman with vulvar squamous cell carcinoma (VSCC) underwent vulvectomy and adjuvant chemoradiation, developing acute radiation dermatitis. Recurrent VSCC required further surgery, and reconstruction was complicated by wound necrosis, which was treated with debridement, quarter-strength sodium hypochlorite and advanced dressings. Following a third vulvectomy for further recurrence, she again demonstrated impaired wound healing. Despite ongoing management, cancer persists.Case 2: A 73-year-old woman with locally advanced endometrial adenocarcinoma received chemotherapy, external radiation, brachytherapy, hysterectomy with bilateral salpingo-oophorectomy, and stereotactic radiation for bone metastasis. Two years post-radiation, she developed vaginal necrosis, which was managed with hypochlorous acid solution, sharp debridement, and hyperbaric oxygen therapy. She recently enrolled in a clinical trial for persistent cancer.In both cases, wound complications delayed optimal cancer-directed therapy.

These cases highlight the importance of a multidisciplinary strategy to manage severe radiation-induced vaginal/vulvar wounds. Focused on pain control, odor reduction, and optimizing the wound environment, care is often palliative given disease complexity, underscoring the challenges in balancing wound healing with ongoing cancer treatment.