REPAIR OF THE PERINEAL DEFECT AFTER RADICAL VULVAR SURGERY - DIRECT CLOSURE VERSUS SHIN FLAPS RECONSTRUCTION - A RETROSPECTIVE COMPARATIVE-STUDY

From 1987 to 1990, 72 consecutive patients with primary untreated vulv ar cancer underwent radical vulvar surgery with skin flaps reconstruct ion of the perineal defect. Postoperative complications, anatomical an d functional results of this group of patients were compared with thos e of an historical control group of 77 patients submitted, at the same institution, to radical vulvectomy without reconstructive procedure f rom 1982 through 1956. The time of operation was significantly longer (180 minutes +/- 15 versus 120 minutes +/- 20) (p = 0.05) for patients submitted to the reconstructive procedure, while there was no statist ically significant difference in intraoperative blood loss and hospita l stay between the 2 groups. In comparison with direct closure, recons tructive procedures resulted in a significant lower rate of wound dehi scences (26% versus 64%) (p = 0.0001), vaginal introitus stenosis (2 v ersus 8) (p = 0.0001), sexual dysfunction (10% versus 50%) (p = 0.0001 ) and misdirection of the urinary stream (1 versus 5) (p = 0.001). It was concluded that skin flaps reconstruction is simple, reduces postop erative morbidity, and provides better anatomical and functional resul ts than direct closure of the perineal defect.