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Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

OBJECTIVE: To create a comprehensive algorithmic approach to reconstruction after vulvar cancer ablative surgery, which includes both traditional and perforator flaps, evaluating anatomical subunits and shape of the defect. METHODS: We retrospectively reviewed 80 cases of reconstruction after vulvar...

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Autores principales: Gentileschi, Stefano, Servillo, Maria, Garganese, Giorgia, Fragomeni, Simona, De Bonis, Francesca, Scambia, Giovanni, Salgarello, Marzia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078823/
https://www.ncbi.nlm.nih.gov/pubmed/27550406
http://dx.doi.org/10.3802/jgo.2016.27.e60
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author Gentileschi, Stefano
Servillo, Maria
Garganese, Giorgia
Fragomeni, Simona
De Bonis, Francesca
Scambia, Giovanni
Salgarello, Marzia
author_facet Gentileschi, Stefano
Servillo, Maria
Garganese, Giorgia
Fragomeni, Simona
De Bonis, Francesca
Scambia, Giovanni
Salgarello, Marzia
author_sort Gentileschi, Stefano
collection PubMed
description OBJECTIVE: To create a comprehensive algorithmic approach to reconstruction after vulvar cancer ablative surgery, which includes both traditional and perforator flaps, evaluating anatomical subunits and shape of the defect. METHODS: We retrospectively reviewed 80 cases of reconstruction after vulvar cancer ablative surgery, performed between June 2006 and January 2016, transferring 101 flaps. We registered the possibility to achieve the complete wound closure, even in presence of very complex defects, and the postoperative complications. On the basis of these experience, analyzing the choices made and considering the complications, we developed an algorithm to help with the selection of the flap in vulvoperineal reconstruction after oncologic ablative surgery for vulvar cancer. RESULTS: We employed eight types of different flaps, including 54 traditional fasciocutaneous V-Y flaps, 23 rectus abdominis myocutaneous flaps, 11 anterolateral thigh flaps, three V-Y gracilis myocutaneous flaps, three free style perforators V-Y flaps from the inner thigh, two Limberg flaps, two lotus flaps, two deep inferior epigastric artery perforator flap, and one superficial circumflex iliac artery perforator flap. The structures most frequently involved in resection were vulva, perineum, mons pubis, groins, vagina, urethra and, more rarely, rectum, bladder, and lower abdominal wall. CONCLUSION: The algorithm we implemented can be a useful tool to help flap selection. The key points in the decision-making process are: anatomical subunits to be covered, overall shape and symmetry of the defect and some patient features such as skin laxity or previous radiotherapy. Perforator flaps, when feasible, must be considered standard in vulvoperineal reconstruction, although in some cases traditional flaps remain the best choice.
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spelling pubmed-50788232016-11-01 Surgical therapy of vulvar cancer: how to choose the correct reconstruction? Gentileschi, Stefano Servillo, Maria Garganese, Giorgia Fragomeni, Simona De Bonis, Francesca Scambia, Giovanni Salgarello, Marzia J Gynecol Oncol Original Article OBJECTIVE: To create a comprehensive algorithmic approach to reconstruction after vulvar cancer ablative surgery, which includes both traditional and perforator flaps, evaluating anatomical subunits and shape of the defect. METHODS: We retrospectively reviewed 80 cases of reconstruction after vulvar cancer ablative surgery, performed between June 2006 and January 2016, transferring 101 flaps. We registered the possibility to achieve the complete wound closure, even in presence of very complex defects, and the postoperative complications. On the basis of these experience, analyzing the choices made and considering the complications, we developed an algorithm to help with the selection of the flap in vulvoperineal reconstruction after oncologic ablative surgery for vulvar cancer. RESULTS: We employed eight types of different flaps, including 54 traditional fasciocutaneous V-Y flaps, 23 rectus abdominis myocutaneous flaps, 11 anterolateral thigh flaps, three V-Y gracilis myocutaneous flaps, three free style perforators V-Y flaps from the inner thigh, two Limberg flaps, two lotus flaps, two deep inferior epigastric artery perforator flap, and one superficial circumflex iliac artery perforator flap. The structures most frequently involved in resection were vulva, perineum, mons pubis, groins, vagina, urethra and, more rarely, rectum, bladder, and lower abdominal wall. CONCLUSION: The algorithm we implemented can be a useful tool to help flap selection. The key points in the decision-making process are: anatomical subunits to be covered, overall shape and symmetry of the defect and some patient features such as skin laxity or previous radiotherapy. Perforator flaps, when feasible, must be considered standard in vulvoperineal reconstruction, although in some cases traditional flaps remain the best choice. Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology 2016-11 2016-07-12 /pmc/articles/PMC5078823/ /pubmed/27550406 http://dx.doi.org/10.3802/jgo.2016.27.e60 Text en Copyright © 2016. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Gentileschi, Stefano
Servillo, Maria
Garganese, Giorgia
Fragomeni, Simona
De Bonis, Francesca
Scambia, Giovanni
Salgarello, Marzia
Surgical therapy of vulvar cancer: how to choose the correct reconstruction?
title Surgical therapy of vulvar cancer: how to choose the correct reconstruction?
title_full Surgical therapy of vulvar cancer: how to choose the correct reconstruction?
title_fullStr Surgical therapy of vulvar cancer: how to choose the correct reconstruction?
title_full_unstemmed Surgical therapy of vulvar cancer: how to choose the correct reconstruction?
title_short Surgical therapy of vulvar cancer: how to choose the correct reconstruction?
title_sort surgical therapy of vulvar cancer: how to choose the correct reconstruction?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078823/
https://www.ncbi.nlm.nih.gov/pubmed/27550406
http://dx.doi.org/10.3802/jgo.2016.27.e60
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