superficial vulvar skin excision

Superficial vaginal resection of the vulva for the surgical treatment of vulvar and vestibular gland cancer. Superficial (skin) vulvectomy removes only the whole or part of the skin and mucosa of the lesion and preserves the subcutaneous tissue and deep structures. The extent of resection depends on the extent and location of the VIN lesion and partial and complete superficial vulvar resection. Curing disease: Indication 1. Vulvar dysplasia (VIN) is extensive. 2, vulvar dysplasia (VIN) lesions can not rule out invasive cancer. 3, vulvar Paget disease has no evidence for invasive adenocarcinoma. 4, very few cases are also used for refractory sclerosis. Contraindications 1. Acute inflammation of the vulva. 2. Invasive cancer and tuberculosis. 3. Severe diabetes. Preoperative preparation 1. Take a shower in the evening before surgery or take a bath with chlorxidene. 2, if you want to remove the skin around the anus, the lower colon cleansing enema. 3. Antibiotics are prevented from infection on the 1st or the day before surgery. 4, plan skin transplantation, choose to prepare the donor site, protective skin zone. Surgical procedure 1. The patient empties the bladder. If VIN has infiltrated into the posterior perineal body, the buttocks should be probed out of the operating table for easy operation. 2. Use the marker pen to delineate the skin area. The suspect specimen area should be biopsied and carefully marked. During the operation, colposcopy and acetic acid test can be used to observe the small lesions, and the appropriate surgical range can be marked and the depth of the operation is only shallow. 3, the outer annular incision from the center of the anterior part of the perineum to the clitoris vertical incision (should avoid damage to the hair follicle), respectively, along the bilateral perineum continue down to 2/3 of the distal end of the perineal body. Use the tissue forceps to lift the upper edge of the labial fat pad, blunt or use an electric knife to separate the avascular loose tissue gap between the skin edge and the labia fat pad to the midline, and then separate forward and backward until the inner annular margin of the vestibule . 4, remove the genital skin of the vulva in the anterior segment of the vulva, continue to separate the skin with an electric knife until the clitoris foreskin, near the base of the glandular gland, to the inner annular cutting edge. Be careful here to avoid cutting the clitoris. 5. The inner annular incision is completed after crossing the scaphoid fossa and ends at the outer edge of the hymen ring. The free vulva skin is unfolded, cut straight from the midline to the clitoris, and then the skin surrounding the clitoris is circumscribed and the inner annular incision is continued to extend backward and downward to communicate with the outer ring incision. 6, the removal of the posterior vulva skin resection of the outer edge of the hymen ring to the perineal skin, it is necessary to electrocoagulation of the annular incision and difficult bleeding of the posterior margin of the vulva. Since there is no natural subcutaneous tissue space under the skin of the posterior portion of the labia majora, the perineal body and the scaphoid fossa, it is difficult to maintain the depth of the separation cut surface. 7. Resection of the posterior part of the perineum When the VIN affects the posterior part of the perineum, the scope needs to be expanded. Separate the subcutaneous tunnel along the marking line to the anus, free the superficial sphincter attachment, and retain its integrity. Separate and remove the level of the dentate line on the anal canal mucosa. If the anal canal mucosa is not completely removed, pathological examination of the surgical margin is required. 8, the vulva is sutured inside and outside the annular incision, the wound is washed with warm physiological saline, try to relieve the skin tension, it is best to use a single fiber absorbable intestinal line (polyqlyconate) suture wound. When the posterior perineal is difficult to suture, the layered thick skin graft (STSG) can be used to repair the wound. complication 1, urinary tract infections. 2. The transplanted skin piece is slightly detached and damaged. 3, donor site infection, delayed healing, scar hyperplasia and itching. 4, anal area transplantation, the patient may have a temporary loss of feeling, short-term tension loose stools or exhaust relaxation.