Vulvar-Vaginal Reconstruction

Excerpt

According to the Centers for Disease Control (CDC), approximately 6500 women were diagnosed with vulvar cancer in 2020. While primary vaginal cancer is relatively uncommon and more likely the result of local invasion from surrounding structures, approximately 1 in 100 000 women will be diagnosed with in situ or invasive vaginal cancer each year. The average age at diagnosis for both vulvar and vaginal cancer is between 60 to 70 years, and most primary cancers are of squamous cell origin.

Risk factors for vulvar cancer include cigarette smoking, prior history of vulvar cancer, cervical intraepithelial neoplasia, lichen sclerosis, and immunodeficiency. Similarly, the most common risk factors for vaginal cancer include human papillomavirus (HPV), increased number of sexual partners, early age of first intercourse, and cigarette smoking. Vulvar cancers are typically diagnosed early with disease confined to the primary location, while vaginal cancers are diagnosed later, with half of patients presenting with greater than stage II disease. The type of cancer, stage of disease, location, oncologist’s surgical approach, and expectations of future function all contribute to the plastic surgeon’s reconstructive algorithm.