Closure of Wide Local Excision Of the Vulva

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Closure of Wide Local Excision
Of the Vulva

Early intraepithelial neoplasias of the vulva frequently have multicentric foci of disease. To adequately excise these lesions with an appropriate surgical margin of 2 cm, wide local excision of the vulva may be required. This kind of excision can be closed by mobilizing the skin lateral to the incision and creating a relaxing incision at an appropriate place to allow coverage of the vulvar defect. This technique provides a skin flap with the blood supply coming from both the mons pubis femoral area and the skin covering the buttocks.

Physiologic Changes. The neoplastic lesion is excised, and primary closure of the wound is made without distortion of the vulva or stricture of the vaginal orifice.

Points of Caution. Prior to excision of the lesion, the margin of normal skin to be removed is measured with a centimeter ruler and outlined with a marking pen. This will ensure adequate margins around the neoplastic lesion.

The skin flap must be adequately mobilized in order to move it easily. Hemostasis is essential.
Suction drainage should be utilized.

Technique

A wide local excision of the vulva is made. The incision is carried down both sides of the vulva to points parallel to the anus. This permits closure of the perineal body without tension.

The tissue lateral to the excised area is sufficiently undermined to provide adequate coverage. The site is selected for the second incision, either at the crural fold or on the leg.

The relaxing incision on the leg has been made, and the skin flap has been moved medially and sutured to the margin of the vulvar skin. Note the two angle line of incision parallel to the anus and how they connect with the U-shaped incision of the skin flap.

The skin lateral to the second incision is undermined and mobilized for primary closure of the relaxing incision.

The lesions on the vulva have been adequately excised; the defect in the vulva is now closed with a skin flap that is brought medially from the tissue lateral to the vulva out onto the skin of the leg.

It is important that suction drains are placed under the skin flap and, when they no longer produce fluid, are removed.