Garví-Morcillo, Javier

SanNicolas-Griñan, María

Sánchez-Zapata, María I.

Revista Peruana de Investigación en Salud

English

LAReferencia - Red Federada de Repositorios Institucionales de Publicaciones Científicas Latinoamericanas

Surgery for recurrence of vulvar cancer and immediate reconstruction with pudendal fasciocutaneous flapCirugía de recidiva de cáncer de vulva y reconstrucción inmediata con colgajo fasciocutáneo del pudendo1, 1,&Javier Garví-Morcillo %,a 1,&, María SanNicolas-Griñan ,  María I. Sánchez-Zapata1Hospital General Universitario Santa Lucía, Cartegena, España%Resident Intern Physician of Obstetrics and Gynecology&Associate Physician of Obstetrics and GynecologyORCID:ahttps://orcid.org/0000-0002-8827-836XCorresponding author:Javier Garví MorcilloPostal Address: Gynecology and Obstetrics Service, Santa Lucía University Hospital.Minarete Street, s/n, 30202 Cartagena, Murcia, España.Email: garvimorcillojavier@gmail.comReception date: march 08, 2021Approval date: may 30, 2021Quote as: Garví-Morcillo J, SanNicolas-Griñan M,  Sánchez-Zapata MI. Cirugía de recidiva de cáncer de vulva y reconstrucción inmediata con colgajo fasciocutáneo del pudendo. Rev. Peru. Investig. Salud. [Internet]; 5(3): 233-234. Available from: http://revistas.unheval.edu.pe/index.php/repis/article/view/9702616-6097/©2021. Peruvian Journal of Health Research. This is an Open Access article under the CC-BYlicense (https://creativecommons.org/licenses/by/4.0). It allows copying and redistributing the material in any medium or format. You must give credit appropriately, provide a link to the license, and indicate if changes have been made.A 82-year-old woman operated on 15 years ago for squamous cell carcinoma of the vulva. A simple vulvectomy plus bilateral inguinal lymphadenectomy was performed (1 of 7 lymph nodes affected on the left and right side, free of lesion), thus it is stage as a FIGO IIIA (1). Subsequently, adjuvant radiotherapy was applied. After seven years free of disease, the patient decided not to continue the oncological controls. She was referred again to gynecology consultations due to vaginal bleeding. In the anamnesis, he refers to presenting lesions on the vulva for a year and the exploration shows the scar from the previous surgery and an ulcerated lesion that affects the upper third of both labia majora and the central area in contact with the urethra (Image 1).A PET-CT and an MRI of the pelvis were requested, which reported tumor recurrence in the vulvectomy bed, with no evidence of lymph node or distant spread. Through multidisciplinary management, joint surgery was decided between oncological gynecology, urology and plastic surgery, with wide resection of the vulvar lesion and the distal third of the urethra (Image 2), and immediate reconstruction using a fasciocutaneous flap of the pudendal (Image 3). The pathological report reported a well-differentiated and infiltrating Squamous Cell Carcinoma with free surgical margins.REVISTA PERUANA DE INVESTIGACIÓN EN SALUDIMAGES IN MEDICINEhttp://revistas.unheval.edu.pe/index.php/repis/https://doi.org/10.35839/repis.5.3.970233ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(3), july - september: 233-234Figure 1. Ulcerative lesion that affects the upper third of both labia majora and central area in contact with the urethra.Figure 2. Wide resection of the vulvar lesion and the distal third of the urethra.Vulvar cancer, although infrequent (less 1% of gynecological tumors), is a pathology that, due to its extensive surgery and the advanced age of its patients (2), presents a high morbidity and mortality (3). Its insidious symptoms (itching and irritation) cause its diagnosis to be delayed, even in case of recurrence. Most recurrences occur in the first two years after treatment, however, up to 35% have a recurrence at five years or more, thus requiring long-term follow-up (4).Gynecological pathology is forgotten in postmenopausal patients. Its high suspicion is essential for its early diagnosis and thus improve the quality of life of patients. Three months after surgery, our patient continues without signs of recurrence, but with urinary incontinence.References 1. Smadja C, Blumgart LH. The biliary tract and the anatomy of biliary exposure. In Blumgart LH, Ed Surgery of the liver and biliary tract: Churchill Livingstone, Edinburgh, 1988; 1: 11-12.2. Kafle A, Adhikari B, Shrestha R, Ranjit N. Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications From a Cadaveric Study. J Nepal Health Res Counc. 2019;17(1):90‐93. Published 2019 Apr 28. doi:10.33314/jnhrc.20123. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010 Jul;211(1):132-8. doi: 10.1016/j.jamcollsurg.2010.02.053. Epub 2010 May 26. PMID: 20610259.ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(3), july - september: 231-232232 Almada M, Sánchez L, Pouy ASpinal accessory nerve injury due to cervical ganglion biopsyLesión del nervio Espinal accesorio ocasionada por biopsia de ganglio cervical1,Luis G. Domínguez-Carrillo %,a 2,&, Luis G. Domínguez-Gasca1Universidad de Guanajuato, México2Hospital Ángeles León, León, Guanajuato. México%Rehabilitation Medicine Specialist&Orthopedist, Joint SurgeryORCID:ahttps://orcid.org/0000-0002-1985-4837Corresponding author:Dr. Luis Gerardo Domínguez CarrilloPostal Address: Universidad de Guanajuato, MéxicoEmail: lgdominguez@hotmail.comReception date: april 14, 2021Approval date: may 30, 2021Quote as: Domínguez-Carrillo LG, Domínguez-Gasca LG. Lesión del nervio Espinal accesorio ocasionada biopsia de ganglio cervical. Rev. Peru. Investig. Salud. [Internet]; 5(3): 235. Available from: http://revistas.unheval.edu.pe/index.php/repis/article/view/10512616-6097/©2021. Peruvian Journal of Health Research. This is an Open Access article under the CC-BYlicense (https://creativecommons.org/licenses/by/4.0). It allows copying and redistributing the material in any medium or format. You must give credit appropriately, provide a link to the license, and indicate if changes have been made.A 32-year-old female patient, as an important antecedent: a lymph node biopsy was performed on the anterolateral face of the neck (zone II), presenting immediate moderate pain in the surgical area with radiation to the left neck, shoulder and arm, and immediate abduction difficulty; 30 days later, he noticed subsidence of the supraclavicular region. Physical examination: scar 3 cm in length on the anterior border of the trapezius muscle at the junction of the upper third with the middle third and perpendicular to it; shoulder descent, right trapezius muscle atrophy, ipsilateral supraclavicular fossa subsidence, arches of motion limited to 70 ° of abduction (Figure 1)The spinal accessory nerve is susceptible to injury, since in its course between the sternocleidomastoid and trapezius muscles it becomes superficial and is found in the subcutaneous tissue in the posterior triangle of the neck (1); the etiology of its injury, which causes paralysis of the trapezius muscle, is multiple; the most frequently reported occurs during biopsy or excision of lymph nodes or tumors in the posterior triangle of the neck. Its treatment is surgical, starting with neurorrhaphy and if it does not respond, muscle transpositions are used to achieve shoulder abduction and correct the winged scapula (2).REVISTA PERUANA DE INVESTIGACIÓN EN SALUDIMAGES IN MEDICINEhttp://revistas.unheval.edu.pe/index.php/repis/https://doi.org/10.35839/repis.5.3.1051235ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(3), julio - setiembre: 235Figure 1.  Clinical photographs: in (A) right lateral neck area, showing a 3 cm scar covering border areas of zone II-III. In (B), when requesting shoulder abduction, the sinking of the right supraclavicular fossa is noticeable, in addition to the impossibility of abduction above 70 ° due to injury to the spinal accessory nerve.Authors' contributionAll authors participated in the entire research process.Conflicts of InterestsThere is no conflict of interest to declare.FundingThe research was self - funded.References1. Ferraresi S, Basso E, Pino MA, Dipasquale P. Iatrogenic accessory nerve palsy after laterocervical lymph node biopsy-clinico-surgical considerations on 42 cases and review of the literature. Clin Surg. 2017; 2: 1466-1470.2. Li T, Yang ZZ, Deng Y, Xiao M, Jiang C, Wang JW. Indirect transfer of the sternal head of the pectoralis major with autogenous semitendinosus augmentation to treat scapular winging secondary to long thoracic nerve palsy. J Shoulder Elbow Surg. 2017; 26: 1970-1977. doi: 10.1016/j.jse.2017.04.015.Authors' contributionAll authors participated in the entire research process.Conflicts of InterestsThere is no conflict of interest to declare.FundingThe research was self - funded.References 1. FIGO Committee on Gynecologic Oncology. FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. mayo de 2014;125(2):97-8. 2. Alkatout I, Schubert M, Garbrecht N, Weigel MT, Jonat W, Mundhenke C, et al. Vulvar cancer: epidemiology, clinical presentation, and management options. Int J Womens Health. 2015;7:305-13. 3. Torres-Lobatón A, Vázquez-Tinajero A, Jiménez-Arroyo EP, Barra-Martínez R, Oliva-Posada JC, Morgan-Ortiz F. Cáncer de vulva. Repercusiones del tratamiento quirúrgico: experiencia con 151 pacientes. Ginecol Obstet México. 2018;86:423-33. 4. Oncoguía SEGO: Cáncer Escamoso Invasor de Vulva 2016. Guías de práctica clínica en cáncer ginecológico y mamario. Publicaciones SEGO, Febrero 2016.ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(3), july - september: 233-234234 Garví-Morcillo J, SanNicolas-Griñan M,  Sánchez-Zapata MIImage 3 . Pudendal fasciocutaneous flap reconstruction.

Cirugía de recidiva de cáncer de vulva y reconstrucción inmediata con colgajo fasciocutáneo del pudendo

Javier Garví-Morcillo

María SanNicolas-Griñan

María I. Sánchez-Zapata

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Revistas de Investigación UNHEVAL (Universidad Nacional Hermilio Valdizán de Huánuco)

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Cirugía de recidiva de cáncer de vulva y reconstrucción inmediata con colgajo fasciocutáneo del pudendo

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