Griffiths C, Howell R S, Boinpally H, Jimenez E, Chalas E, Musa F, Gorenstein S
Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA.
Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA.
Gynecol Oncol Rep. 2018 Apr 13;24:90-93. doi: 10.1016/j.gore.2018.04.002. eCollection 2018 May.
Postoperative management of patients with vulvar cancer is associated with a high incidence of poor wound healing and radiation -induced late tissue necrosis. This case series demonstrates the impact on wound healing with the use of hyperbaric oxygen therapy and advanced wound care following radical vulvectomy and/or radiation therapy. A retrospective case series was performed of all patients from 2016 to 2017 with lower genital cancer who underwent radical surgery with or without chemoradiation treatment, experienced wound dehiscence or late tissue radionecrosis, and were treated with advanced wound care, including hyperbaric oxygen therapy (HBO). Five patients were included with a mean age of 63; four had squamous cell carcinoma and one patient had vaginal adenocarcinoma secondary to prior diethylstilbestrol exposure. Three patients underwent radical vulvectomy. All received pelvic radiation therapy, subsequently experienced wound complications, and were managed with advanced wound care and HBO. The mean reduction in wound area at the final wound follow up visit after completion of HBO therapy was found to be 76%, ranging 42-95%, with an average follow up of five months. The mean number of HBO sessions per patient was 58. Complete tissue granulation or significant improvement in tissue radionecrosis was present in all patients. Advanced wound care and hyperbaric oxygen therapy are beneficial in the management of postoperative wound complications. Prospective studies are needed to identify the optimal use of perioperative hyperbaric oxygen and appropriate wound care for patients with gynecologic malignancies.
外阴癌患者的术后管理与伤口愈合不良和放疗引起的晚期组织坏死的高发生率相关。本病例系列展示了在根治性外阴切除术后和/或放疗后使用高压氧治疗和先进伤口护理对伤口愈合的影响。对2016年至2017年所有患有下生殖道癌的患者进行了一项回顾性病例系列研究，这些患者接受了根治性手术，无论是否接受放化疗，出现了伤口裂开或晚期组织放射性坏死，并接受了包括高压氧治疗（HBO）在内的先进伤口护理。纳入了5名患者，平均年龄63岁；4例为鳞状细胞癌，1例为既往己烯雌酚暴露继发的阴道腺癌。3例患者接受了根治性外阴切除术。所有患者均接受了盆腔放疗，随后出现伤口并发症，并接受了先进伤口护理和HBO治疗。在完成HBO治疗后的最后一次伤口随访中，发现伤口面积平均缩小了76%，范围为42%-95%，平均随访时间为5个月。每位患者的HBO治疗平均次数为58次。所有患者均出现完全组织肉芽形成或组织放射性坏死显著改善。先进伤口护理和高压氧治疗对外科术后伤口并发症的管理有益。需要进行前瞻性研究，以确定围手术期高压氧的最佳使用方法以及对妇科恶性肿瘤患者的适当伤口护理。
