Vulvar cancer resection with V–Y advancement flap reconstruction (2025)

1. http://orcid.org/0009-0008-8748-7718Kimberly Lizet Morales Palomino1,
2. Santiago Domingo Del Pozo2,
3. Marta Gurrea2,
4. http://orcid.org/0000-0003-2706-7865Marta Arnaez2,
5. http://orcid.org/0000-0002-2971-1899Victor Lago2 and
6. http://orcid.org/0000-0003-0524-6213Pablo Padilla-Iserte2

1. ¹Obstetrics and Gynecology Unit, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
2. ²Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain

1. Correspondence to Dr Kimberly Lizet Morales Palomino, Obstetrics and Gynecology Unit, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico; kimberlylizet95{at}gmail.com

• Vulva
• Surgical Flaps
• Surgical Procedures, Operative
• Vulvar Diseases

Vulvar cancer accounts for approximately 5% of all gynecological cancers. Squamous cell carcinomas make up 95% of all vulvar cancers. The vast majority of squamous cell carcinomas affect predominantly elderly women.1

A patient was referred for multidisciplinary care as her chief complaint was post-menopausal bleeding, vaginal discomfort, and a bulky vaginal mass. She had a history of dyslipidemia, hypertension, diabetes mellitus type 2, osteoporosis, and Crohn’s disease. At physical examination a vulvar lesion of approximately 8 cm was seen in the left labia majora. A vulvar biopsy was undertaken which showed squamous cell carcinoma with necrosis and poorly differentiated areas. The vulvar cancer was International Federation of Gynecology and Obstetrics stage III.2 A chest, abdominal and pelvic CT scan found no pulmonary lesions but a left inguinal adenopathy of 9.7 mm. A partial radical vulvectomy with V–Y advancement flap reconstruction and unilateral inguinofemoral lymphadenectomy was made. 3 The histopathology report was undifferentiated neoplasm with metastasis proximal to the clitoris, tumor with free margins and four ganglia positive for metastasis from a total of nine.

Surgery is the primary treatment for vulvar cancer. Vulvar tumors should be removed with a radical local excision with the aim of obtaining histological tumor-free margins. The type of reconstruction is based on patient/tumor characteristics and experience of the surgical team. Currently, the repair methods reported include skin grafts, fasciocutaneous flaps, and myocutaneous flaps. The primary objectives of vulvar defect reconstruction are closure without any tension, less scarring of the perineum, and suturing of the donor area in a single stage. For treating a major defect of the labia majora, the literature recommends repair of the vulva and thigh root with a V–Y advancement flap. This involves mobilizing the adjacent skin and underlying subcutaneous tissue to cover the primary defect. 4 Vulvar reconstruction is critical for cosmetic, functional, and psychological reasons. Additionally, post-operative intercourse is crucial, especially in this type of surgery due to the high risk of complications, which can be reduced with proper surgical techniques.

Footnotes

• Contributors SD, MG and MA provided their knowledge, surgical skills and expertise for the making of this video. SD is responsible for the overall content as guarantor.

• Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Competing interests None declared.

• Provenance and peer review Not commissioned; externally peer reviewed.