FIELD: medicine; operative gynecology; oncogynecology.
SUBSTANCE: after suturing the wound defect from the area of posterior soldering by sequential stitching of perianal skin with a posterior wall of vagina with caprone threads, a skin flap covering the entire pubic region is formed, flap is cut with the help of a scalpel from a medial thigh surface, the ratio of height to width is not more than 2 to 1, while cutting a flap depth of the cut reaches a wide fascia of thigh. Next stage involves McMillan—Donati firm suture between a front angle of a wound and a gluteal fold in a place where the flap has finished. Flap collection point is closed tightly with a continuous suture of vicryl from the inner to the outer one with further application of separate interrupted sutures. Then flap is moved to wound after vulvectomy and fixed by means of nylon threads in "clockwise direction", from McMillan—Donati suture, applied earlier, before the beginning of the opposite wall of vagina. Subcutaneous fatty tissue of the flap is not closed. Formed lower edge of flap is serially anchored to anterior wall of sheath and skin of paraurethral zone to level of urethra, to the resected portion of the urethra, the flap is not filed, in an area opposite the gluteal fold, a skin flap is formed, the size of the flap depends on the length of the resected vagina, this flap is cut from an edge of vagina to a gluteal fold, short of a fascial box with preservation of blood supply. Formed graft is anchored to the remaining vaginal wall, the remaining lower edge of the right flap.
EFFECT: method enables maintaining the possibility of reproductive function in patients with locally advanced forms of vulvar cancer, reducing the risk of developing postoperative complications, such as infectious complications, exacerbation of the extragenital pathology, and reducing the postoperative patient's day.
1 cl, 3 dwg, 1 ex
