Radical vulvectomy by two different surgical incisions.

Objective: To determine the outcome of radical vulvectomy by two different surgical incisions (butterfly vs triple incision) for the treatment of vulval carcinoma.

Methods: A comparative study was conducted from January 1992 to July 2003 at Military Hospital Rawalpindi and Fauji Foundation Hospital Rawalpindi. A total of 35 patients were included in this study. One patient received supportive therapy at stage IVB. Out of 34 patients, 23 (67.64%) underwent radical vulvectomy by butterfly incision and 11 (32.35%) radical vulvectomy by triple incision technique. Data regarding history, clinical examination, surgical procedures, per-operative complications, post-operative complications, hospital stay, recurrence and mortality was collected and analyzed.

Results: The percentages of partial wound dehiscence (86.36% vs. 18.18% p = 0.00), wound induration (100% Vs 72.7%, p = 0.008), infection (22.72% vs: 9.09%, p = 0.637) and lymphoedema (9.0% vs. Zero, p = 0.542) were higher in butterfly incision group as compared to triple incision group respectively. The per-operative blood loss (750 +/- 36.9 ml vs. 381 +/- 14.7 ml, p-value: < 0.01), operative time (136.91 +/- 14.73 min Vs 81.82 +/- 14.71 min, p = 0.00) and hospital stay (19.05 +/- 3.27 days Vs 9.09 +/- 0.7 days, p = 0.00) were significantly higher in butterfly incision as compared to triple incision respectively. The recurrence rate in butterfly incision was comparable to triple incision group (14.28% vs. 18.18%, p = 0.572). In the butterfly group one patient died per-operatively and another patient died within one year after surgery.

Conclusion: Radical vulvectomy by triple incision has comparable recurrence rate but significantly less mortality and morbidity rates when compared to butterfly incision.