Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap

Anna Amelia Caretto, Gianluigi Stefanizzi, Simona Maria Fragomeni, Alex Federico, Luca Tagliaferri, Valentina Lancellotta, Giovanni Scambia, Stefano Gentileschi, Anna Amelia Caretto, Gianluigi Stefanizzi, Simona Maria Fragomeni, Alex Federico, Luca Tagliaferri, Valentina Lancellotta, Giovanni Scambia, Stefano Gentileschi

Abstract

Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs' volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student's t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL.

Keywords: SCIP flap; groin dissection; gynecologic cancer; inguinal lymphadenectomy; inguinofemoral lymphadenectomy; lymphatic flap; lymphedema; lymphedema prevention; personalized medicine; vulvar cancer.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Frontal and posterior pre-operative view of an 80-year-old woman undergoing surgery for vulvar cancer, involving bilateral groin dissection and reconstruction of the right inguinal area with L-SCIP. (b) Frontal and posterior view of the same patient one year after surgery. The black arrow indicates the flap skin island at the level of the right groin. The patient shows moderate swelling of the left lower limb (untreated side) and mild swelling of the right limb. (c) The same patient, 4 years after surgery, shows severe swelling of the left lower limb and no swelling of the right limb.
Figure 2
Figure 2
(a) Frontal and posterior pre-operative view of a 77-year-old woman undergoing surgery for vulvar cancer, involving bilateral groin dissection and reconstruction of the right inguinal area with L-SCIP. (b) Frontal and posterior view of the same patient one year after surgery. The black arrow indicates the flap skin island at the level of the right groin. The patient shows moderate swelling of the left lower limb (untreated side) and mild swelling of the right lower limb. (c) The same patient, 5 years after surgery, shows severe swelling of the left lower limb and mild swelling of the right lower limb.
Figure 3
Figure 3
(a) Wound breakdown after groin dissection and reconstruction with L-SCIP flap at the level of the left inguinal area. The white arrow indicates the buried part of the flap, showing granulation tissue after VAC-therapy. The presence of the flap prevented femoral vessels exposure. (b) Postoperative view of the same patient after debridement and primary closure of the wound dehiscence.
Figure 4
Figure 4
This picture shows the two patients of our series affected by postoperative infection. (a,b) Anterior and posterior view of a 57-year-old woman showing lymphangitis of the right lower limb (untreated side) involving the anterior and posterior surface of the thigh 3 months after bilateral groin dissection for vulvar cancer and reconstruction of the left inguinal area with L-SCIP. The black arrow indicates the skin island of the flap. This patient was healed by antibiotic therapy. (c) Postoperative fluid collection and infection at the level of the left inguinal area 1 month after bilateral groin dissection and reconstruction of the right inguinal area with L-SCIP. The black arrow indicates the skin island of the flap in the right groin. This patient was healed by antibiotic therapy and repeated fluid aspiration.

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