Highlights
-
•
A pedicled fasciocutaneous flap that exploits the internal pudendal blood supply and is a reliable surgical option for vulvar cosmesis.
-
•
Radical excision can be an option for patients with localized disease and good performance status.
-
•
Reconstruction of the vulva in an irradiated field may require complex flap procedures with multidisciplinary teams.
Keywords: Vulvar carcinoma, Surgical video, Vulvectomy, Singapore flap
Abstract
Introduction
Vulvar cancer has an overall low incidence, accounting for approximately 3–5% of all gynecological malignancies.
Case: We present a case of locally recurrent Stage IIIA squamous cell carcinoma of the vulva in a 51-year-old healthy African American female. She was initially treated with primary chemoradiation with cisplatin sensitization and boost to primary tumor up to 70 Gray. Post-treatment biopsies revealed complete pathologic response. She later presented with local recurrence to the primary site of the clitoris and vulva, with no evidence of metastasis on imaging, with progressive disease despite treatment with immunotherapy.
Methods
Biopsy-proven disease progression was present on the clitoris, entire left labia minora, and a portion of the right labia minora with no evidence of metastasis on imaging. Surgical resection for localized recurrence was recommended, and she underwent radical anterior vulvectomy, distal urethrectomy, and vulvar reconstruction with bilateral Singapore fasciocutaneous flap as part of a multidisciplinary team. Patient underwent several prophylactic hyperbaric oxygen treatments. There were no issues with postoperative wound healing.
Conclusion
Treatment with radical excision often requires multidisciplinary teams for complex reconstructions to restore vulvar anatomy in the setting of prior radiation, especially for those patients desiring the ability to have penetrative intercourse in the future. There are few surgical videos that describe these types of vulvar excisions and subsequent reconstructions. This video provides a unique approach to vulvar reconstruction in a previously irradiated field.
Fig. 1.
Bilateral Singapore fasciocutaneous flap after anterior vulvectomy and distal urethrectomy for localized recurrent vulvar carcinoma one week postoperatively.
Acknowledgements
We would like to thank the San Antonio Uniformed Services Health Education Consortium Graduate Medical Education Program for supporting the development of this surgical video.
Prior Presentation
Society of Gynecologic Oncology Annual Meeting on Women’s Cancer, San Diego, California, 2024.
Funding Source
None declared.
Clinical Trial Registration
Not applicable.
Institutional Review Board (Human Subjects)
Not applicable.
Patient Consent
Consent for use of medical imagery obtained on 09Jun2023.
Institutional Animal Care and Use Committee (IACUC)
Not applicable.
Data Availability Statement
No references were utilized.
Disclaimer
The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army or the Department of Defense or the U.S. Government.
Institutional Clearance
Institutional clearance approved.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.gore.2024.101373.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
No references were utilized.