title: Vulvar Reconstruction Following Surgery for Vulvar Cancer Using a Stepladder V-Y Advancement Medial Thigh Flap.
abstract: OBJECTIVE
  The aim of this study was to identify the risks and benefits of the stepladder V-Y advancement medial thigh flap for vulvovaginal reconstruction in comparison to direct skin closure.
  
  
  METHODS
  Fifty-four patients with vulvar cancer treated in our hospital between 1992 and 2013 were enrolled in this study. The cohort group (group A) consisted of 25 patients who underwent surgery from August 2006 until April 2013. During this period, we changed our surgical paradigm to incorporate reconstructive plastic surgery immediately following surgery for vulvar cancer performed by gynecologic oncologists. The control group (group B) consisted of 29 patients treated between 1992 and August 2006. During this period, our surgical approach was limited to direct skin closure with no reconstructive plastic surgery. Perioperative findings and clinical outcomes were compared retrospectively.
  
  
  RESULTS
  Patient characteristics and surgical procedures, other than the reconstructive surgery, were the same for the 2 groups. The mean blood loss and operative times were similar, and there were no major complications in either group; however, the average length of hospital stay was significantly shorter in group A (P = 0.04).
  
  
  CONCLUSIONS
  Stepladder V-Y advancement medial thigh flap lowers posttreatment morbidity and improves quality of life for patients with vulvar cancer. Rapid recovery from surgery is reflected in the short hospital stay, and it enables immediate induction of adjuvant therapy. It may possibly contribute to improved treatment outcome.
authors.affiliation: Departments of *Gynecology and †Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Nomura
authors.forename: Takuma
authors.initials: T
authors.lastname: Maeda
authors.forename: Tomoka
authors.initials: T
authors.lastname: Usami
authors.forename: Akiko
authors.initials: A
authors.lastname: Abe
authors.forename: Akiko
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Maki
authors.initials: M
authors.lastname: Matoda
authors.forename: Sanshiro
authors.initials: S
authors.lastname: Okamoto
authors.forename: Eiji
authors.initials: E
authors.lastname: Kondo
authors.forename: Kohei
authors.initials: K
authors.lastname: Omatsu
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kato
authors.forename: Kenji
authors.initials: K
authors.lastname: Umayahara
authors.forename: Kuniko
authors.initials: K
authors.lastname: Utsugi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takeshima
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sawaizumi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010001:Osteitis Deformans / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013848:Thigh / Q000473:pathology / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*