of the Vulva
of Urethral Caruncle
Gland Cyst Marsupialization
of Vulvar Skin, with Split-Thickness Skin Graft
of Wide Local Excision of the Vulva
of the Vulva, With Primary Closure or Z-plasty Flap
of the Vulva
of the Vulva
Vulva by the Loop Electrical Excision Procedure (LEEP)
of Labial Fusion
Excision Of Hypertrophied Clitoris
Closure of Wide Local Excision
Of the Vulva
Early intraepithelial neoplasias of the vulva frequently have multicentric
foci of disease. To adequately excise these lesions with an appropriate
surgical margin of 2 cm, wide local excision of the vulva may be required.
This kind of excision can be closed by mobilizing the skin lateral
to the incision and creating a relaxing incision at an appropriate
place to allow coverage of the vulvar defect. This technique provides
a skin flap with the blood supply coming from both the mons pubis femoral
area and the skin covering the buttocks.
Physiologic Changes. The neoplastic
lesion is excised, and primary closure of the wound is made without
distortion of the vulva or stricture of the vaginal orifice.
Points of Caution. Prior to excision
of the lesion, the margin of normal skin to be removed is measured
with a centimeter ruler and outlined with a marking pen. This will
ensure adequate margins around the neoplastic lesion.
The skin flap must be adequately
mobilized in order to move it easily. Hemostasis is essential.
Suction drainage should be utilized.
A wide local excision of the
vulva is made. The incision is carried down both sides of the
vulva to points parallel to the anus. This permits closure of
the perineal body without tension.
The tissue lateral to the
excised area is sufficiently undermined to provide adequate coverage.
The site is selected for the second incision, either at the crural
fold or on the leg.
The relaxing incision on the leg
has been made, and the skin flap has been moved medially and sutured
to the margin of the vulvar skin. Note the two angle line of incision
parallel to the anus and how they connect with the U-shaped incision
of the skin flap.
The skin lateral to the second incision
is undermined and mobilized for primary closure of the relaxing
The lesions on the vulva have been adequately
excised; the defect in the vulva is now closed with a skin
flap that is brought medially from the tissue lateral to the
vulva out onto the skin of the leg.
It is important that suction
drains are placed under the skin flap and, when they no longer
produce fluid, are removed.