2-14. RADICAL VULVECTOMY AND GROIN LYMPHADENECTOMY
a. General. This operation involves abdominal and perineal dissection, which
may be performed as a one-stage or two-stage operation. A mass dissection is done
on the following structures: a large segment of skin from the abdomen and groins, the
labia majora, labia minora, clitoris, mons pubis, and terminal portions of the urethra,
vagina, and other vulvular organs, as well as the superficial and/or deep inguinal nodes,
portions of the round ligaments, portions of the saphenous veins, and the lesion itself. It
also involves reconstruction of the vaginal walls and pelvic floor and closure of the
abdominal wounds. At a later date, placement of full-thickness pinch grafts may be
done if the denuded area of the vulva appears too large for normal granulation.
b. Preparation of the Patient. The patient lies supine and may be placed in the
Trendelenburg and lithotomy positions, as required for the various stages. The skin
preparation includes both the abdomen and vulva, and the skin of the thighs is usually
prepared down to the knees. As in other radical surgery, the nursing team should be
prepared to measure blood loss and anticipate procedures to combat shock.
c. Operative Procedure (see figure 2-4).
Lymphadenectomy portion of the surgery.
(a) The first skin incision is made on the side opposite the primary
lesion. The end of the incised skin is grasped with Allis forceps. The incision is carried
down to the aponeuroses of the external oblique muscle.
(b) The fascia over the inguinal ligament and the fascia lata of the
upper thigh are exposed, separated, and freed, using retractors, knife, scissors,
hemostats, and sponges.
(c) Bleeding vessels are clamped and ligated, including the superficial
iliac artery and vein, the epigastric artery and vein, and the superficial external pudendal
artery and vein using Crile hemostats and ligatures or chromic gut or silk number0 or
(d) The fibers of the inguinal, hypogastric, and femoral nerves are
resected, using Metzenbaum or Harrington scissors, tissue forceps without teeth, and
(e) The lymphatic node beds may be identified with silk or metal clips.
long, sharp dissection scissors are needed.
(f) The large tissue surfaces are exposed for complete dissection by
means of retractors and protected by warm, wet laparotomy packs. High saphenous
vein ligation is performed, using scissors, forceps, hemostats, and chromic gut or silk