Enhancing outcomes in vulvar cancer surgery: A comprehensive approach to complication prevention

OBJECTIVE

This study aimed to identify and synthesize strategies that reduce surgical complications in vulvar cancer, focusing on preoperative, intraoperative, and postoperative measures.

STUDY DESIGN

A literature review was conducted by searching PubMed, Scopus, and ScienceDirect databases. Studies from 2000 to 2024 published in English and Spanish language were included. Articles were included if they addressed preoperative assessment, surgical approaches, lymph node management, wound care, or psychosocial support in vulvar cancer patients.

RESULTS

Conservative surgical techniques-particularly the triple-incision approach and sentinel lymph node biopsy (SLNB)-demonstrate lower morbidity while maintaining acceptable oncologic control, especially in early-stage disease. Video endoscopic inguinal lymphadenectomy has shown promise in further reducing wound complications, although its adoption is limited to specialized centers with technical expertise. Optimizing patients preoperatively through glycemic control, nutritional support, and smoking cessation can decrease the risk of wound infection and dehiscence. Postoperative interventions such as meticulous wound care, negative-pressure wound therapy, and early lymphatic drainage techniques help prevent chronic lymphedema. Additionally, psychosocial and sexual counseling emerges as crucial for addressing the significant emotional and functional challenges associated with vulvar surgery.

CONCLUSIONS

A multidisciplinary, patient-centered approach is essential to mitigate the high morbidity traditionally linked to vulvar cancer surgery. Ongoing research into advanced surgical methods, standardized perioperative protocols, and holistic patient support will be key to further improving outcomes, preserving quality of life, and reducing the burden of long-term complications in this rare but challenging malignancy.

Application of Negative-Pressure Wound Therapy in Patients with Wound Complications after Flap Repair for Vulvar Cancer: A Retrospective Study

OBJECTIVE

To analyze the characteristics of postoperative wound complications (WCs) in patients following vulvectomy with flap repair and evaluate the efficacy of negative-pressure wound therapy (NPWT) in wound healing.

METHODS

This study retrospectively reviewed 17 patients with WCs following vulvectomy with flap repair at a tertiary comprehensive hospital from January 2016 to December 2022. All patients were treated with NPWT, and the wound healing rate, healing time, and NPWT-related complications were observed.

RESULTS

The most common WCs were seroma and lymphorrhea (52.94%; nine cases), followed by wound infection (35.29%, six cases), fat liquefaction (23.53%, four cases), wound dehiscence (17.65%, three cases), and wound ischemia (5.88%, one case). The main locations for flap WCs were the vulva (64.71%), thigh (35.29%), and pubic symphysis (23.53%). One patient halted treatment; the remaining 16 patients all achieved complete healing with a mean healing time of 43.50 ± 17.92 days. One complication was associated with the use of NPWT: procedural pain (17.65%, three cases).

CONCLUSIONS

The use of NPWT may contribute to accelerated wound healing after flap repair in vulvar cancer and is safe for clinical application.

Use of negative pressure wound therapy after infection and flap dehiscence in radical vulvectomy: A case report

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Radical vulvectomy is a very agressive surgery.

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Deshiscence of vulvar wound is one of the most feared complications.

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Negative wound pressure therapy could be incorporate in the management of this complications.

Introduction

Vulvar cancer has a lower incidence in high income countries, but is rising, in part, due to the high life expectancy in these societies. Radical vulvectomy is still the standard treatment in initial stages. Wound dehiscence contitututes one of the most common postoperative complications.

Presentation of case

A 76 year old patient with a squamous cell carcinoma of the vulva, FIGO staged, IIIb is presented. Radical vulvectomy and bilateral inguinal lymph node dissection with lotus petal flaps reconstruction are performed as the first treatment. Wound infection and dehiscence of lotus petal flaps was seen postoperatively. Initial management consisted in antibiotics administration and removing necrotic tissue from surgical wound. After this initial treatment, negative wound pressure therapy was applied for 37 days with good results.

Discussion

Wound dehiscence in radical vulvectomy remains the most frequent complication in the treatment of vulvar cancer. The treatment of this complications is still challenging for most gynecologic oncologist surgeons.

Conclusion

The utilization of the negative wound pressure therapy could contribute to reduce hospitalization and the direct and indirect costs of these complications.