An Experience of Reconstruction of Vulva following Malignancy Extirpation in a Tertiary Hospital in Eastern India

INTRODUCTION: Treatment of CA (carcinoma) vulva, although a rare malignancy in the elderly females, involves a multidisciplinary team approach between the Oncologists and the Surgical team (Extirpative and the Reconstructive surgeons). Owning to the complex three dimensional anatomy and the location, reconstruction is a challenging job. There is a wide array of reconstructive options which has evolved from the past, taking into consideration various factors related to the stage of the disease, the nature and extent of the defect and the wishes and compliance of the patients. AIMS AND OBJECTIVES- To evaluate the different reconstructive options following CA vulva extirpation curtailed to the wound size, extent and stage of the malignancy. METHODOLOGY- In this retrospective study patients with Stages II and IIIA CA vulva aged between 50 to 70 years were included in this study, prepared and operated with extirpation of the defects, groin dissection and reconstruction. They were postoperatively monitored for complications and flap viability, discharged and followed up regularly at OPD. RESULTS- Over 1 year, we operated on 10 patients of CA vulva, with a mean age of 64.9 years. The post excision defects (modified radical or radical vulvectomy with groin dissection) were reconstructed with different flaps ranging from simple advancement flaps to more complex regional ones like the lotus petal, gracilis and rectus abdominis flaps. The site of tumour was predominantly in labia majora. The mean size of defect created after excision of tumour was 7 x 4.2 cm length and breadthwise.90 % flaps survived completely with partial necrosis of one lotus petal flap. CONCLUSION- Reconstruction of Vulva following extirpation of malignancy requires a holistic multidisciplinary approach and involves a wide array of reconstructive options tailored to each specific case to achieve better wound coverage, escalated wound healing and disease free survival, preserving the form and function.