simple vulvectomy

Simple vulvectomy is used for surgical treatment of vulvar and vestibular large adenocarcinoma. In the past, simple vulvar resection was used as the standard procedure for VIN. It is currently considered that the resection range is not suitable for this type of disease, and the use is reduced. The standard simple vulvar resection range and depth exceeds superficial superficial skin resection, including vulvar skin mucosa, subcutaneous tissue, deep fascia, clitoris, clitoris foreskin, labia majora, labia fat pad. The range should reach the junction of the vulva and hairless growth. For patients with pelvic floor defects such as bladder urethral bulging, anterior and posterior vaginal wall bulging, rectal bulging, perineal laceration and tension urinary incontinence, surgery can be repaired at the same time. Treatment of diseases: vulvar adenomas, vulvar cancer Indication Simple vulvectomy is available for: 1. Suitable for non-invasive, extensive VIN in elderly women. 2. Extensive VIN and suspected invasive cancer in women with senile functional decline. 3. Vulvar Paget disease. 4. Patients with VIN who underwent resection of the vulva or superficial vulvar skin, biopsy confirmed pathological infiltration, and depth <1mm, no lymphatic vascular infiltration, no invasive carcinoma and atypical hyperplasia lesions; pathological differentiation I Grade, infiltration depth <2mm vulvar cancer. 5. Extensive and huge condyloma acuminata, purulent sweat gland inflammation, inguinal granuloma and sexually transmitted lymphogranuloma. Preoperative preparation 1. Clean the enema 1 day before surgery. 2. The perineum 1:5000 potassium permanganate solution bath. 3. Pre-dose antibiotics before surgery. 4. For high-risk patients with deep venous thrombosis, preoperative use of calf inflatable balloon and low-dose heparin. 5. Empty the bladder. Surgical procedure Skin incision The scribing marks were cut out, and the outer ring and the inner ring were incision respectively. The cutting edge was 3 to 5 mm away from the lesion. The elliptical outer ring incision starts from the center of the perineum to the top of the clitoris, and the skin is cut to the lower side of the perineum until it reaches 1/2 of the perineal body, and stops above the anal sphincter. At the same time, a small wedge shape is formed below the outer ring incision to prevent Stitch deformity. The inner ring is incision in the vestibule of the vagina, and an elliptical circular incision is made from the base of the vaginal foreskin along the inner side of the vaginal opening. The urethral opening is made through the vestibule through the vestibule and the urethral opening through the basal part of the labia minora, just outside the hymen ring. Connected, stopped at the labia. 2. Surgical depth Includes vulvar skin and subcutaneous tissue until under the labial fat pad. The entire procedure is required to be performed in the superficial layer of the genitourinary fascia. The superficial branch of the internal pudendal artery encountered during ligation. If there is a lesion around the anus, the tissue around the anus and the external anal sphincter should be removed. 3. Vulvar anterior resection The inner and outer ring incision of the pubic skin was extended forward, and the skin edge was clamped with a forceps, and the skin was separated sharply. The pedicle was inserted into the subcutaneous tissue of the pubic sac, and the ligament of the clitoris was traversed, the dorsal artery of the clitoris and the clitoris. The median vertical groove (anterior union) in front of the clitoris must be extensively removed to avoid endogenous infestation, infection or other complications of the incision during suturing. The depth of the excision of the clitoris should be above the pubic symphysis. But it is not necessary to be lower than the pubic bone to prevent uncontrolled bleeding. When the specimen removed from the anterior vaginal region is pulled downward, the clitoral suspensory ligament is easily separated from the pubic symphysis, so that the tissue between the clitoris and the urethra has sufficient freeness to facilitate resection. 4. Posterior resection Along the posterior margin of the vulva, the skin specimen peeled off at the front is pulled, and the mucosa of the scaphoid fossa is removed. The skin of the perineal membrane of the hymen ring is removed, and the specimen is removed along the anus to prevent injury to the external anal sphincter and levator ani muscle. 5. Vulva formation The inner and outer ring incision skin mucosa is simply sutured or vertically sutured with a No. 1 silk thread or absorbable thread. If the incision flap is tight and difficult to complete the suture, the double thigh can be adducted and flexed to reduce the tissue tension. If the suture tension of the skin mucosa around the urethral opening is too large, forced suturing may cause excessive tension of the urethra or distortion of the lower urethra. If necessary, the suture will not be sutured, and the wound will be exposed, and the granulation will be naturally repaired after the day. If the genital wound is large, it is feasible to transplant free skin graft or gracilis flap. complication 1. Pay attention to deep vein thrombosis. 2. The wound is cracked and it should be given antibiotics, local dressing, and it will heal naturally. 3. Infection and abscess formation around the urethral opening, there is a secondary pubic osteomyelitis, must be actively treated.