Vito Andrea Capozzi1, Valentina Ceni2, Giulio Sozzi3, Alessandra Cianciolo2, Giulia Gambino2, Martina Pugliese2, Roberto Berretta2. 1. Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 14, 43125, Parma, Italy. Electronic address: vitoandrea.capozzi@studenti.unipr.it. 2. Department of Gynecology and Obstetrics, University of Parma, Via Gramsci, 14, 43125, Parma, Italy. 3. Department of Gynecologic Oncology, University of Palermo, Piazza Nicola Leotta, 4, 90127, Palermo, Italy.
Abstract
INTRODUCTION: Vulvar cancer often requires radical vulvectomy with subsequent vulvar flap. Approximately in 20-60% of cases, there are post-operative complications ranging from infection to flap necrosis that often require reoperation. Several methods have been described to verify the vitality of the flap, but these are often expensive and require specific machinery that is not generally present in a gynecological clinic. In this case report, we present a viability verification of VY fasciocutaneous advancement flap for vulvar reconstruction by Endoscopic Near-Infrared and Indocyanine Green. METHODOLOGY: The patient was a 67-year-old woman with FIGO IB ≤ 4 cm squamous cell vulvar cancer with absence of inguinal lymphadenopathy. The lesion appeared about 35 mm from the lateral margin of the large left lip and extended to the left inguinocrural fold. The patient underwent left inguinal lymphadenectomy and left radical hemivulvectomy with a left fasciocutaneous medial-thigh advancement flap. For the flap evaluation, we endovenous administered 50 mg of Indocyanine Green diluted in 10 ml of saline solution. After 10 min we visualized the flap margin with a near-infrared laparoscopic view. The evaluation was repeated at the end of the surgical procedure and we confirmed the good vascularization of the flap. RESULTS: No early or late post-operative complications were obtained. There was no wound dehiscence, marginal necrosis or surgical site infection. CONCLUSIONS: Verifying the viability of the vulvar flap using near-infrared laparoscopic optics was easy to use, reproducible and highly economical technique. This could be a reproducible alternative to other more expensive techniques.
INTRODUCTION:Vulvar cancer often requires radical vulvectomy with subsequent vulvar flap. Approximately in 20-60% of cases, there are post-operative complications ranging from infection to flap necrosis that often require reoperation. Several methods have been described to verify the vitality of the flap, but these are often expensive and require specific machinery that is not generally present in a gynecological clinic. In this case report, we present a viability verification of VY fasciocutaneous advancement flap for vulvar reconstruction by Endoscopic Near-Infrared and Indocyanine Green. METHODOLOGY: The patient was a 67-year-old woman with FIGO IB ≤ 4 cm squamous cell vulvar cancer with absence of inguinal lymphadenopathy. The lesion appeared about 35 mm from the lateral margin of the large left lip and extended to the left inguinocrural fold. The patient underwent left inguinal lymphadenectomy and left radical hemivulvectomy with a left fasciocutaneous medial-thigh advancement flap. For the flap evaluation, we endovenous administered 50 mg of Indocyanine Green diluted in 10 ml of saline solution. After 10 min we visualized the flap margin with a near-infrared laparoscopic view. The evaluation was repeated at the end of the surgical procedure and we confirmed the good vascularization of the flap. RESULTS: No early or late post-operative complications were obtained. There was no wound dehiscence, marginal necrosis or surgical site infection. CONCLUSIONS: Verifying the viability of the vulvar flap using near-infrared laparoscopic optics was easy to use, reproducible and highly economical technique. This could be a reproducible alternative to other more expensive techniques.
Authors: Beryl L Manning-Geist; Renee A Cowan; Brooke Schlappe; Kenya Braxton; Yukio Sonoda; Kara Long Roche; Mario M Leitao; Dennis S Chi; Oliver Zivanovic; Nadeem R Abu-Rustum; Jennifer J Mueller Journal: Gynecol Oncol Rep Date: 2022-02-03
Authors: Luigi Carlo Turco; Giuseppe Vizzielli; Virginia Vargiu; Salvatore Gueli Alletti; Maria De Ninno; Gabriella Ferrandina; Luigi Pedone Anchora; Giovanni Scambia; Francesco Cosentino Journal: Front Oncol Date: 2021-11-15 Impact factor: 6.244