Surgeons who treat patients with vulvar malignancy should be aware of the serious defect (Fig) following radical vulvectomy, which need immediate reconstruction.
Numerous vascularized flaps have been designed and validated for obliterating the dead space and closing the vulvoperineal skin defect. But the reconstructive surgery with flaps is somewhat like a way that rob Peter to pay Paul.
I had systematically searched the relevant articles in Pubmed with the search strategy and selection criteria “vulvar malignancies”; “vulva”, “vulvar”, “vulval”;“vulvectomy” ; “vulvar reconstruction” combined with“vulvovaginal reconstruction”; “quality of life”, no paper regarding the procedure of vulvar transplantation was found.
Is it possible to perform allogeneic vulvar transplantation with anastomosis of the internal pudendal artery aiming at recovering an acceptable cosmetic appearance.
Thank you for your attention.
Look for P.Knapstein´s work about reconstructive surgery of the female genital area in cases with vulvar cancer and you will you don´t have to rob Peter to pay Paul
I would ask the assistance of a plastic surgeon who may be able to do a split skin graft. Looking at the picture, the bed looks clean. There does not seem to be much infection. If I had to do this, the choices would be a free skin graft from the lower abdomen, or a skin-on Singapore flap graft from the thigh crease as is done for obstetric fistula.
See technique and video at
Browning A1, Williams G2, Petros P3,4.
Skin flap vaginal augmentation helps prevent and cure post obstetric fistula repair urine leakage: a critical anatomical analysis. BJOG. 2017 Oct 11. doi: 10.1111/1471-0528.14953. [Epub ahead of print]
General graft principles need to be observed
Do not operate on an infected site. Be gentle with the tissues, preserve blood supply to operative site (or get it with a skin-on Singapore flap), meticulous hemostasis ,fine suture material , avoid skin tension,avoid dead spaces- they collect hematomas which will disrupt the graft
Hamid Asmouki Dear Dr. Hamid Asmouki, Many thanks for your comment, I agree with your suggestion. As the skin defect is close to anus opening, colostomy should be considered before reconstructive surgery or vulvar transplantation for avoiding the postoperative infection.
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