(g) The femoral canal is cleaned of its lymphatics, and the round
ligament is clamped, cut, and ligated.
(h) The peritoneum is freed from the muscles, fascia is dissected free,
deep lymphatic nodes and areolar tissue are removed, and vessels and their
attachments are clamped, cut, and ligated, using long curved scissors, long tissue
forceps, hemostats, and ligatures.
(i) The lesion is removed. In deep pelvic lymphadenectomy, the
ureter may be exposed.
(j) The inguinal canal is reconstructed, and the wound is partially
closed, using chromic gut and silk sutures. An indwelling system of urinary drainage is
established, and the wound is dressed.
Vulvectomy portion of the surgery.
(a) The skin incisions of the abdomen and thigh join with those for
vulvectomy. The incisions in the vulva encircle the urethra.
(b) In the vulval dissection, terminal portions of the urethra and vagina,
the mons pubis, clitoris, frenulum, prepuce of the clitoris, and Bartholin's and Skene's
glands, plus fascial coverings of the vulva are removed with the specimen.
(c) Reconstruction of the vaginal walls and the pelvic floor is
completed. An indwelling system or urinary drainage is established, suction drains are
placed into the denuded area, the wound is dressed with layers of petrolatum gauze,
and a light pressure dressing is applied.
2-15. VAGINAL PLASTIC OPERATION (ANTERIOR AND POSTERIOR REPAIR)
(1) This operation involves reconstruction of the vaginal walls, the pelvic
floor, and the muscles and fascia of the rectum, urethra, bladder, and perineum. It
involves a vaginal repair to correct a cystocele and/or rectocele, restore the bladder to
its normal position, and strengthen the vagina and the pelvic floor.
(2) A cystocele is formed when the portion of the anterior vaginal wall that is
between the cervix and the urethra and the base of the bladder herniate inferiorly. The
hernia of the bladder protrudes through the torn musculofascial components of the
vaginal anterior wall, with protrusion into the vaginal outlet. A defect in the anterior
vaginal wall is usually caused by childbirth or an inherent weakness. A large herniation
may cause a sensation of pressure in the vagina or present as a mass at or through the