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Abstract
Introduction/Background Paget’s disease of the vulva is a rare malignancy for which radical surgical approach such as vulvectomy or wide local excision with adequate surgical margins should be performed. Vulvectomy is complicated by complex wound failure (CWF) in 26–85% of cases. CWF usually occurs 8 to 10 days after surgery. Schimp et al. firstly reported the use of vacuum-assisted closure (VAC) after vulvectomy.
Methodology A 68 years old polymorbid obese patient with recurrent Paget’s disease of the vulva underwent vulvectomy with multiple frozen sections of the edges followed by vulvar reconstruction using suprafascial flap. First signs of CWF could be seen on the 9th day with conventional treatment methods. On the 15th day the 2nd surgery for necrectomy was needed. The primary closure after necrectomy was impossible, CWF area was large so we decided to try VAC although we struggled with air leakage around the vagina introitus. We were not able to maintain an airtight seal so we invented a vaginal phantom made of condom filled with drapes. We used two ports connected to the Y connector applying 125 mmHg continuous pressure. Urine derivation was needed by Foley catheter On the 5th dressing change we started with dynamic sutures. We were concerned about wound infection and blood supply of flaps but VAC did not allow spreading the infection.
Results The VAC treatment lasted for 10 weeks, 14 dressing changes in general anesthesia and last 5 were tolerated without anesthesia.
Conclusion Due to our experience, we can say that VAC can be successfully applied for treatment of CWF in genital area. Urine derivation is needed when an area of external urethral orifice is involved in the wound otherwise urine can disrupt an airtight seal. To prevent air leakage in vagina introitus we successfully inserted the vaginal phantom.