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Vulvectomy:Removaloftheexternalgenitalia Partial:doneonlyasabiopsytoestablishdiagnosis Simple:donewhenbenignlesionispresent Radical:formalignantlesions Anatomy:Vulva Physiology:Externalgenitailiamonspubis,labiamajora/minora,clitoris,Bartholinsglands, fourchette,andperineum lubricateandprovidesensationduringsexualintercourse protectionofreproductivesystem Pathophysiology: multifocalinsituneoplasiaofthevulva condylomata(anogenitalwarts) Pagetsdisease(lesion/adenocarcinoma) vulvarcancer DiagnosticInterventionWidelocallesionexcisionandmedicaltherapyarepreferredpriorto

riorto vulvectomy.Vulvectomyisonlyusedwhentheseothertreatmentsfail Diagnosticexams: Vulvarbiopsy Routinepelvicexams Selfvulvarexams cystoscopy proctoscopy xrayexaminationofthelungs intravenousurography(asneeded) Preoptesting: Bloodandurinetests chestxray echocardiogramifyouareover50 Surgicalintervention Specialconsiderations: Beawareofthechangethepatientisgoingthroughsexually Incisionisgoingtoneedlotsofspecialcareafterwardssinceitsinanareaofhigh movementandtension PatientusuallyhasaFoleycatheter Anesthesia:general

Positioning:Lithotomy Skinprep:Vaginalprepalongwithlowerabdomenstartingattheumbilicusandextendingfrom thenipplestomidthighs Draping:Lithotomy Incision:beginsatthevaginaloutletandcirclesaroundthevulva(elliptical)AVOIDanal sphincter/orifice Supplies Drains,culturetubes,suturesanddressings Foleycatheter Blades(2)#10,anda#15 Basinset Needlemagnet/counter ESUpencilsandcordswithholdersandscrapers Dissectors(peanut/kitner) Perinealdrains(Hemovac) Graduateandaseptosyringe Equipment: Preferredstirrups Bovie Suctions(2) CVPunit Scalestoweighsponges Sequentialcompressiondevice Forcedairwarmingblanket,ifordered Paddedshoulderbraces Instruments Vaginaltray GYNset Plasticset(supplement)forreconstruction MinorproceduresTray Selfretainingretractors Hemoclipappliers Vascularprocedurestrayfor Proceduralsteps: 1. Outlinewithskinmarker

2. 3. 4. 5. 6. 7. 8. 9.

Injectlocalwithepinepherine Incisionwith10bladebeginningatvaginaloutletsourethralborderscanbeviewed Vaginalepitheliumisunderminedforashortdistance Ellipticalincisioncontinuesatouterskinmargins Incisioniscarriedalmosttoanalorifice Dissectioncontinuesintoadiposelayer,NOTtofasciaormuscles Hemostasisisachieved Tissuelayersareapproximatedwithanabsorbablesuture,vaginalepitheliumiseverted overtheperineum 10. Smalldrainisplacedonlowerendofincisionanddressingsareplaced Counts Dressingmaterial:firmpackovertheentirearea,heldinplacebypanties Specimencare:Removedenblocpassedofftopathologyasusual Postopdestination:PACU Postopcare: Thewoundneedstobekeptverydryandcleanconstantirrigation,sitzbathandair dryingrequired Underwearshouldntbewornandclothesshouldbeloosefittingtoavoidpressureand tensionontheincision Mostpatientsshouldstayinbedandonlydolightwalkingforfirst23weekstoprevent clottinginthelegs Sexualintercoursecanberesumedin68weeks Totalrecoveryisupto3months Prognosis:Good,dependsonhowactivethepatientisandifthewoundstaysclosed. Complications: Death Hemorrhage Woundinfection Wounddehiscencedebridementmaybeneededand2ndintentionhealingallowed Woundclass/management CLASSI:Cleannoentranceintogenitalia

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