Excision of vulva skin

A cutaneous vulvectomy is indicated for young women with extensive in situ carcinoma of the vulva. The goal in such an operation is to remove the in situ carcinoma but to leave a functional vulva that is psychologically as well as physically satisfactory to the patient. To accomplish this, the surgeon removes the cancerous vulvar epithelium and replaces it with a split-thickness skin graft of normal epithelium from a selected donor site.

Physiologic Changes. The in situ cancer is removed.

Points of Caution. Meticulous hemostasis should be complete in the wound prior to applying the split-thickness skin graft. This aids essential nutrition through transudation during the first 48-72 hours, until microcapillary neoangiogenesis connects the graft with the general circulation within the recipient site.

Technique

The patient is placed in the dorsal lithotomy position. The perineum is prepped and draped. The skin to be removed is carefully outlined with brilliant green solution.

An incision is made down to the dermis. An Allis clamp is placed on the skin, and a scalpel is used to carefully dissect the skin off the dermis

The dissection follows the outline of the incision around the external genitalia, removing the involved skin. Note that noninvolved structures may be left intact.

A split-thickness skin graft is taken as shown in the section on McIndoe Vaginoplasty for Neovagina under Vagina and Urethra. The graft is tailored to fit the wound. Edges of the graft are sutured to the edges of the epithelium of the labia with interrupted 3-0 nylon sutures, the ends of which are left long and tagged with small hemostats.

The skin has been placed on the vulva and sutured to the remaining skin of the vulva and vagina. A Graftac stapler is used to staple through the split-thickness skin graft into the bed to hold the graft in place for the required number of days.