d. Because pelvic and vaginal procedures involve manipulation of the ureters,
bladder, and urethra, indwelling urinary drainage systems are frequently established
during surgery. Either the urethral Foley catheter or the suprapubic Silastic cannula
directly into the bladder may be used, depending on the surgeon's preference and the
type of surgery.
2-13. SIMPLE VULVECTOMY
a. General. This operation involves the removal of the labia majora, the labia
minora, and possibly the clitoris and perianal area, with a Z-plasty closure. Simple
vulvectomy may be done to treat leukoplakia vulvae because of its known association
with carcinoma of the vulva, an intractable pruritus in older women, or other types of
skin lesions such as kraurosis and vitiligo. It may also be used for carcinoma in situ of
the vulva, Bowen's disease of the vulva, and Padget's disease of the vulva.
b. Patient Preparation. The patient is anesthetized and placed in the lithotomy
position. The operative site is cleansed, using the standard sterile vaginal set, and the
patient is draped for lithotomy.
c. Operative Procedure.
(1) The affected skin is incised, usually starting anteriorly above the clitoris.
The incision is continued laterally to the labia majora, to the midline of the perineum,
and around the anus if it is involved. A knife, holding forceps, gauze sponges on
holders, tissue forceps, and Allis forceps are needed. Bleeding vessels are clamped.
Bleeding is controlled by the electrosurgical unit or plain or chromic gut ligatures.
(2) Periurethral and perivaginal incisions are made. Bleeding of this
vascular area is controlled by means of Kelly or Crile hemostats, ligatures, and sponges
on holders. Allis-Adair forceps are used for holding diseased tissues.
(3) All skin and subcutaneous tissues are undermined and mobilized, using
curved dissecting tissue forceps, scissors, Allis forceps, and sponges on holders.
(4) The wound is closed, usually by simple bilateral Z-plasty closure with
chromic gut number2-0 or number3-0. In some cases, an excision of the skin is made
around the anus to accomplish a slide skin flap.
(5) Drains or continuous suction sometimes are placed in the dependent
areas, an indwelling system or urinary drainage is established, and gauze packing is
placed in the vagina. Petrolatum gauze and dressings are applied and held in place
with plastic tape and a binder.