Abstract：
OBJECTIVE: To assess if the use of a V-Y reconstructive flap after excisional radical surgery positively influences the surgical outcomes in patients with vulvar cancer.
METHODS: This was a multicenter, retrospective, controlled study. Surgical outcomes and complication rates of women with invasive vulvar cancer who underwent radical surgery and vulvar reconstruction and those who underwent radical surgery without the reconstruction step were compared. Only patients who underwent bilateral or unilateral V-Y advancement fascio-cutaneous flaps were included in the reconstruction group. Univariate and multivariate logistic regression models were used to analyze predicting variables for their association with complication rates.
RESULTS: Overall, 361 patients were included: 190 (52%) underwent the reconstructive step after the excisional radical procedure and were compared with 171 (47.4%) who did not undergo the reconstructive step. At multivariate analysis, body mass index >30 kg/m2 (odds ratio (OR) 3.36, p=0.007) and diabetes (OR 2.62, p<0.022) were independently correlated with wound infection. Moreover, increasing age (OR 1.52, p=0.009), body mass index >30 kg/m2 (OR 3.21, p=0.002,) and International Federation of Gynecology and Obstetrics (FIGO) stages III-IV (OR 2.25, p=0.017) were independent predictors of wound dehiscence. A significant reduction in the incidence of postoperative wound complications among patients who underwent V-Y reconstructive flaps was demonstrated. This was correlated more significantly in women with lesions >4 cm.
CONCLUSIONS: The adoption of V-Y flaps in vulvar surgery was correlated with reduced surgical related complications, particularly in vulnerable patients involving large surgical defects following excisional radical procedures.
METHODS: This was a multicenter, retrospective, controlled study. Surgical outcomes and complication rates of women with invasive vulvar cancer who underwent radical surgery and vulvar reconstruction and those who underwent radical surgery without the reconstruction step were compared. Only patients who underwent bilateral or unilateral V-Y advancement fascio-cutaneous flaps were included in the reconstruction group. Univariate and multivariate logistic regression models were used to analyze predicting variables for their association with complication rates.
RESULTS: Overall, 361 patients were included: 190 (52%) underwent the reconstructive step after the excisional radical procedure and were compared with 171 (47.4%) who did not undergo the reconstructive step. At multivariate analysis, body mass index >30 kg/m2 (odds ratio (OR) 3.36, p=0.007) and diabetes (OR 2.62, p<0.022) were independently correlated with wound infection. Moreover, increasing age (OR 1.52, p=0.009), body mass index >30 kg/m2 (OR 3.21, p=0.002,) and International Federation of Gynecology and Obstetrics (FIGO) stages III-IV (OR 2.25, p=0.017) were independent predictors of wound dehiscence. A significant reduction in the incidence of postoperative wound complications among patients who underwent V-Y reconstructive flaps was demonstrated. This was correlated more significantly in women with lesions >4 cm.
CONCLUSIONS: The adoption of V-Y flaps in vulvar surgery was correlated with reduced surgical related complications, particularly in vulnerable patients involving large surgical defects following excisional radical procedures.
摘要：
目的：评估切除根治术后使用V-Y重建皮瓣是否对外阴癌患者的手术结局产生积极影响。
方法：这是一个多中心，回顾性,对照研究。比较了接受根治性手术和外阴重建的浸润性外阴癌女性与未接受重建步骤的根治性手术女性的手术结果和并发症发生率。仅将接受双侧或单侧V-Y推进筋膜皮瓣的患者纳入重建组。使用单变量和多变量逻辑回归模型来分析预测变量与并发症发生率的相关性。
结果：总体而言，包括361例患者：190例（52％）在切除根治性手术后接受了重建步骤，并与没有接受重建步骤的171例（47.4％）进行了比较。在多变量分析中，体重指数>30kg/m2（比值比（OR）3.36，p=0.007）和糖尿病（OR2.62，p<0.022）与伤口感染独立相关。此外，年龄增长（OR1.52，p=0.009），体重指数>30kg/m2(OR3.21,p=0.002)和国际妇产科联合会(FIGO)III-IV期(OR2.25,p=0.017)是伤口裂开的独立预测因子.证明了接受V-Y重建皮瓣的患者术后伤口并发症的发生率显着降低。这在病变>4cm的女性中更显著相关。
结论：在外阴手术中采用V-Y皮瓣可减少手术相关并发症，特别是在切除根治性手术后涉及大型手术缺陷的脆弱患者中。
方法：这是一个多中心，回顾性,对照研究。比较了接受根治性手术和外阴重建的浸润性外阴癌女性与未接受重建步骤的根治性手术女性的手术结果和并发症发生率。仅将接受双侧或单侧V-Y推进筋膜皮瓣的患者纳入重建组。使用单变量和多变量逻辑回归模型来分析预测变量与并发症发生率的相关性。
结果：总体而言，包括361例患者：190例（52％）在切除根治性手术后接受了重建步骤，并与没有接受重建步骤的171例（47.4％）进行了比较。在多变量分析中，体重指数>30kg/m2（比值比（OR）3.36，p=0.007）和糖尿病（OR2.62，p<0.022）与伤口感染独立相关。此外，年龄增长（OR1.52，p=0.009），体重指数>30kg/m2(OR3.21,p=0.002)和国际妇产科联合会(FIGO)III-IV期(OR2.25,p=0.017)是伤口裂开的独立预测因子.证明了接受V-Y重建皮瓣的患者术后伤口并发症的发生率显着降低。这在病变>4cm的女性中更显著相关。
结论：在外阴手术中采用V-Y皮瓣可减少手术相关并发症，特别是在切除根治性手术后涉及大型手术缺陷的脆弱患者中。
