title: Inguinofemoral lymphadenectomy: randomized trial comparing inguinal skin access above or below the inguinal ligament.
abstract: BACKGROUND
  Groin wound breakdown, lymphoceles, cellulitis, and chronic leg edema are the most frequent complications of inguinal lymphadenectomy, resulting in severe patient discomfort and significant lengthening of postoperative stay. Despite all innovations, complication rates are still high and inevitable. Our experience suggests that cutaneous flap preparation, identification of the Camper fascia, and preservation of the most lateral lymphatics decrease associated morbidity. The aim of this study is to analyze whether different cutaneous skin flap preparations and their different devascularization (above or below the inguinal ligament), resecting all the lymphofatty tissue, reduce groin wound complications, and whether the same therapeutic approach and number of lymph nodes removed are comparable.
  
  
  METHODS
  This prospective randomized clinical trial of 62 consecutive patients affected by vulvar carcinoma requiring inguinal lymphadenectomy compared skin inguinal incision carried out 3-4 cm above the inguinal ligament (group A) or below it (group B).
  
  
  RESULTS
  Inguinal dehiscence was present in 17 of 53 (32.1%) patients in group B and in 9 of 54 (16.7%) in group A (P=0.10). Lymphocele was observed in 10 of 53 lymphadenectomies (18.9%) in group B and in 3 of 54 dissections (5.6%) in group A (P=0.07). Upper incision allows more precise identification of the Camper fascia, is less painful, and gives better cosmetic results. Moreover, there may be advantage, albeit not statistically significant, regarding flap length, wound dehiscence rate, and speed of wound healing. There was no difference in chronic leg edema, number of nodes removed, or hospital stay.
authors.affiliation: Department of Gynecology, Obstetrics and Perinatology, University of Rome La Sapienza, 00161 Rome, Italy. natalina.manci@uniroma1.it
authors.forename: Natalina
authors.initials: N
authors.lastname: Manci
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Esposito
authors.forename: Carmen
authors.initials: C
authors.lastname: De Falco
authors.forename: Filippo
authors.initials: F
authors.lastname: Bellati
authors.forename: Margherita
authors.initials: M
authors.lastname: Giorgini
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.forename: Pierluigi Benedetti
authors.initials: PB
authors.lastname: Panici
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006119:Groin / Q000473:pathology / Q000601:surgery; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012501:Saphenous Vein / Q000601:surgery; D012867:Skin / Q000294:innervation*; D013524:Surgical Flaps; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*