Vulvar wide local excision, simple vulvectomy, and skinning vulvectomy
- C William Helm, MD
C William Helm, MD
- Consultant Gynaecological Oncologist
- Northern Gynaecological Oncology Centre
- Queen Elizabeth Hospital
Vulvar lesions are a common gynecologic problem. Lesions that are suspicious for malignancy or are premalignant may be excised in a conservative fashion, preserving as much of the vulvar architecture as possible. Treatment approaches also include ablative techniques, (laser, Cavitron ultrasonic surgical aspirator [CUSA]) and pharmacologic therapy .
The techniques for vulvar wide local excision and simple or skinning vulvectomy are reviewed here. Diagnosis and treatment of vulvar lesions, precancer, and cancer are discussed separately. (See "Vulvar lesions: Diagnostic evaluation" and "Vulvar intraepithelial neoplasia" and "Squamous cell carcinoma of the vulva: Staging and surgical treatment".)
INDICATIONS AND CONTRAINDICATIONS
Conservative excisional procedures are performed for selected benign or premalignant conditions of the vulva, including:
●Vulvar intraepithelial neoplasia (VIN) (see "Vulvar intraepithelial neoplasia", section on 'Excision')
●Paget disease of the vulva (see "Vulvar cancer: Epidemiology, diagnosis, histopathology, and treatment of rare histologies", section on 'Paget disease of the vulva')
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- ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
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- Likes WM, Stegbauer C, Tillmanns T, Pruett J. Pilot study of sexual function and quality of life after excision for vulvar intraepithelial neoplasia. J Reprod Med 2007; 52:23.
- Green MS, Naumann RW, Elliot M, et al. Sexual dysfunction following vulvectomy. Gynecol Oncol 2000; 77:73.
- INDICATIONS AND CONTRAINDICATIONS
- SURGICAL ANATOMY
- PREOPERATIVE EVALUATION AND PREPARATION
- Informed consent
- Prophylactic antibiotics
- Other preoperative measures
- OPERATIVE SET-UP
- WIDE LOCAL EXCISION
- SIMPLE VULVECTOMY
- - Vulvectomy
- - Closure
- Postoperative care
- SKINNING VULVECTOMY
- Postoperative care
- Recurrence of VIN after excision
- Effects on sexual function and body image
- SUMMARY AND RECOMMENDATIONS