Hand Lauren C, Maas Talia M, Baka Nadia, Mercier Rebecca J, Greaney Patrick J, Rosenblum Norman G, Kim Christine H
Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, 833 Chestnut Street, 1st Floor, Philadelphia, PA, United States.
Sidney Kimmel Medical College, Thomas Jefferson University Hospital, 834 Chestnut St Ste 320, Philadelphia, PA 19107, United States.
Gynecol Oncol Rep. 2018 Aug 24;26:24-28. doi: 10.1016/j.gore.2018.08.007. eCollection 2018 Nov.
We aimed to analyze the outcomes of patients who underwent vulvectomy with subsequent V-Y fasciocutaneous flap reconstruction.
All medical records of all patients who underwent vulvectomies with V-Y fasciocutaneous flap reconstruction from January 2007 to June 2016 were retrospectively reviewed. Patient clinical and surgical data, demographics, and outcomes were abstracted.
Of the 27 patients, 42 flaps were transferred. A simple vulvectomy was performed in 8 (30%) patients, partial radical vulvectomy in 15 (56%), and radical vulvectomy in 4 (15%). The median area of defect was 30 cm. Minor wound separations occurred in 9 patients (33%). Infectious complications occurred in 4 patients (15%); this included urinary tract infections in 2 (50%), postoperative fevers in 2 (50%), and sepsis in 1 (25%) patient with a UTI. There were no instances of flap necrosis, wound dehiscence, or wound infections. Black race was more likely to be associated with an infectious complication with 3 (75%) patients, compared to white race with 1 (4%) patient ( < .01). The presence of diabetes was more likely to be associated with an infectious complication in 2 (67%) patients, compared to 1 (4%) in non-diabetic patients (p < .01). No other significant association was found during analysis of demographics, medical comorbidities, vulvar pathology, or surgical factors affecting V-Y fasciocutaneous flap infectious complications or minor wound separations.
The use of a V-Y fasciocutaneous advancement flap for vulvar reconstruction is safe and associated with mostly minor complications. Infectious complications were more frequently associated with diabetes, black race, and HIV.
我们旨在分析接受外阴切除术后行V-Y筋膜皮瓣重建术患者的治疗结果。
回顾性分析2007年1月至2016年6月期间所有接受外阴切除术后行V-Y筋膜皮瓣重建术患者的病历。提取患者的临床和手术数据、人口统计学信息及治疗结果。
27例患者中，共转移了42块皮瓣。8例（30%）患者行单纯外阴切除术，15例（56%）行部分根治性外阴切除术，4例（15%）行根治性外阴切除术。缺损的中位面积为30平方厘米。9例患者（33%）出现轻微伤口裂开。4例患者（15%）发生感染并发症；其中包括2例（50%）尿路感染、2例（50%）术后发热以及1例（25%）因尿路感染导致脓毒症的患者。未出现皮瓣坏死、伤口裂开或伤口感染的情况。黑人种族比白人种族更易发生感染并发症，黑人有3例（75%），白人有1例（4%）（P<0.01）。糖尿病患者比非糖尿病患者更易发生感染并发症，糖尿病患者有2例（67%），非糖尿病患者有1例（4%）（P<0.01）。在分析人口统计学、内科合并症、外阴病理学或影响V-Y筋膜皮瓣感染并发症或轻微伤口裂开的手术因素时，未发现其他显著相关性。
使用V-Y筋膜皮瓣推进术进行外阴重建是安全的，且大多伴有轻微并发症。感染并发症更常与糖尿病、黑人种族和艾滋病病毒相关。
