Skinning Vulvectomy

• Skinning Vulvectomy is a surgical technique that removes the outer layers of vulvar skin.
• Its main purpose is to treat conditions like vulvar intraepithelial neoplasia (VIN) or lichen sclerosus.
• The procedure involves excising affected skin and typically replacing it with a skin graft.
• Recovery after skinning vulvectomy includes managing pain, wound care, and restricted activity for several weeks.
• Regular follow-up is crucial to monitor healing and detect any recurrence of the underlying condition.

What is a Skinning Vulvectomy?

A Skinning Vulvectomy is a specialized surgical procedure involving the removal of the superficial skin layers of the vulva, which is the external female genitalia. Unlike a simple or radical vulvectomy, this technique aims to preserve the deeper tissues, including the clitoris and subcutaneous fat, thereby minimizing functional and cosmetic impact. The primary purpose of skinning vulvectomy surgery is to treat vulvar skin conditions like high-grade vulvar intraepithelial neoplasia (VIN) or severe lichen sclerosus, which carry a risk of malignant transformation or cause significant discomfort.

This approach is often chosen when the disease is confined to the skin’s surface and does not involve deeper structures. By carefully excising only the affected skin, surgeons aim to remove the diseased tissue while maintaining as much normal anatomy and function as possible. This conservative yet effective method aims to improve patient quality of life post-surgery compared to more extensive resections.

Surgical Procedure Details

The Skinning vulvectomy procedure details involve several key steps, typically under general anesthesia. The surgeon first identifies and marks the areas of affected vulvar skin to be removed. A thin layer of skin, often including the epidermis and superficial dermis, is then carefully excised. The excision’s extent depends on the size and location of the diseased area, aiming to remove all abnormal tissue while preserving healthy underlying structures.

Once the affected skin is removed, the exposed area often requires coverage, usually with a skin graft. This graft is typically harvested from another part of the patient’s body, such as the inner thigh, and meticulously placed over the denuded vulvar area. The graft is secured with sutures or staples and covered with a bolster dressing to ensure good contact and promote healing. The use of a skin graft is crucial for proper wound closure, aesthetic outcome, and to prevent scarring that could lead to functional issues.

• Anesthesia: General anesthesia is typically administered.
• Excision: The surgeon carefully removes the superficial layers of the vulvar skin affected by the condition.
• Graft Harvest: A thin skin graft is usually taken from a donor site (e.g., inner thigh).
• Graft Placement: The harvested skin graft is meticulously placed over the excised area and secured.
• Dressing: A bolster dressing is applied to ensure the graft adheres properly.

Recovery and Post-Operative Care

Recovery after skinning vulvectomy requires careful wound care and pain management for optimal healing and to minimize complications. Immediately after surgery, patients will experience pain and discomfort, which can be managed with prescribed pain medication. The surgical site will be bandaged, and specific instructions for dressing changes and hygiene will be provided. Keeping the area clean and dry is crucial to prevent infection and promote graft take.

Patients are typically advised to limit physical activity, including sitting for prolonged periods and strenuous exercise, for several weeks to allow the graft to heal properly. Sexual activity is usually restricted for 6-8 weeks or more, as advised by the surgeon. Regular follow-up appointments are essential to monitor the healing process, assess graft viability, and detect any signs of recurrence of the underlying condition. Long-term surveillance is recommended, especially for conditions like VIN, to ensure continued health and address new concerns promptly.