Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
Section Ii:
2-13
2-13. SIMPLE VULVECTOMY
a. General. This operation involves the removal of the labia majora, the labia minora, and possibly the clitoris and perianal area, with a Z-plasty closure. Simple vulvectomy may be done to treat leukoplakia vulvae because of its known association with carcinoma of the vulva, an intractable pruritus in older women, or other types of skin lesions such as kraurosis and vitiligo. It may also be used for carcinoma in situ of the vulva, Bowen's disease of the vulva, and Padget's disease of the vulva.
b. Patient Preparation. The patient is anesthetized and placed in the lithotomy position. The operative site is cleansed, using the standard sterile vaginal set, and the patient is draped for lithotomy.
c. Operative Procedure.
(1) The affected skin is incised, usually starting anteriorly above the clitoris. The incision is continued laterally to the labia majora, to the midline of the perineum, and around the anus if it is involved. A knife, holding forceps, gauze sponges on holders, tissue forceps, and Allis forceps are needed. Bleeding vessels are clamped. Bleeding is controlled by the electrosurgical unit or plain or chromic gut ligatures.
(2) Periurethral and perivaginal incisions are made. Bleeding of this vascular area is controlled by means of Kelly or Crile hemostats, ligatures, and sponges on holders. Allis-Adair forceps are used for holding diseased tissues.
(3) All skin and subcutaneous tissues are undermined and mobilized, using curved dissecting tissue forceps, scissors, Allis forceps, and sponges on holders.
(4) The wound is closed, usually by simple bilateral Z-plasty closure with chromic gut number2-0 or number3-0. In some cases, an excision of the skin is made around the anus to accomplish a slide skin flap.
(5) Drains or continuous suction sometimes are placed in the dependent areas, an indwelling system or urinary drainage is established, and gauze packing is placed in the vagina. Petrolatum gauze and dressings are applied and held in place with plastic tape and a binder.
