Roh Solji, Miyamoto Shimpei, Kitamura Yutaro, Mito Daisuke, Okazaki Mutsumi
Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2021 Apr 20;9(4):e3550. doi: 10.1097/GOX.0000000000003550. eCollection 2021 Apr.
Although primary vulvovaginal reconstruction after vulvectomy has high potential to improve patients' outcomes, flap reconstruction is not an established part of the current standard treatment for vulvar cancer. We report a patient with successful secondary vulvar reconstruction 3 years after radical vulvectomy with direct wound closure. A 69-year-old woman presented with chronic, burning vulvar pain 3 years after radical vulvectomy without reconstruction for stage IB vulvar cancer. Her urethral orifice had everted because of the direct wound closure, which resulted in severe pain on contact. We performed secondary vulvar reconstruction using bilateral 14 × 5 cm gluteal fold flaps. Postoperative pain management and overall aesthetic outcomes were satisfactory. Secondary vulvar reconstruction with gluteal fold flaps can avoid the sequelae resulting from inadequate direct wound closure after radical vulvectomy. Thus, we strongly advocate immediate vulvar reconstruction to prevent such situations.
尽管外阴切除术后进行原发性外阴阴道重建极有可能改善患者的预后，但皮瓣重建并非目前外阴癌标准治疗方案中既定的一部分。我们报告了1例患者，在根治性外阴切除术后采用直接伤口闭合术，3年后成功进行了二期外阴重建。一名69岁女性在因IB期外阴癌行根治性外阴切除术后未进行重建，3年后出现慢性灼痛性外阴疼痛。由于直接伤口闭合，她的尿道口外翻，导致接触时剧痛。我们使用双侧14×5 cm臀褶皮瓣进行了二期外阴重建。术后疼痛管理和整体美学效果均令人满意。采用臀褶皮瓣进行二期外阴重建可避免根治性外阴切除术后直接伤口闭合不当所导致的后遗症。因此，我们强烈主张立即进行外阴重建以预防此类情况。
