Symbolic image of a phoenix rising from floral elements, representing healing and renewal after vulvectomy.

Vulvar Reconstruction After Vulvectomy: Navigating Trends and Ensuring Safer Outcomes

Nico Varela in Health & Wellness December 2025 • 4 min read.

"A comprehensive look at the trends, complications, and critical factors in vulvar reconstruction following vulvectomy, empowering patients with knowledge and support."

Vulvar cancer and other vulvar conditions sometimes necessitate surgical removal of tissue, a procedure known as a vulvectomy. While this surgery can be life-saving, it often leaves significant defects that impact both physical function and emotional well-being. Vulvar reconstruction aims to restore anatomy, function, and quality of life for these patients.

Reconstruction involves various surgical techniques, from primary closure (directly stitching the wound together) to more complex methods using skin flaps and grafts. The choice depends on the extent of tissue removed, the patient's overall health, and other individual factors. However, studies suggest that reconstruction may also increase the risk of complications compared to primary closure.

A recent study published in the International Journal of Gynecological Cancer delved into the trends and complications associated with vulvar reconstruction after vulvectomy. By analyzing data from a large nationwide cohort, researchers sought to identify factors that contribute to complications and to provide insights for improving patient outcomes. This article breaks down the study's findings, offering a clear understanding of the risks and benefits of vulvar reconstruction.

Understanding the Study: A Nationwide Analysis

Symbolic image of a phoenix rising from floral elements, representing healing and renewal after vulvectomy.

The study utilized the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database, a large repository of surgical data from hospitals across the United States. Researchers examined records from 2011 to 2015, focusing on patients who underwent vulvar excisions, both with and without reconstruction. They compared patient characteristics, surgical procedures, and 30-day outcomes to identify potential risk factors and complications associated with reconstruction.

The study identified 2,698 patients who underwent vulvar excision, with only 78 (2.9%) undergoing reconstruction. The researchers found no significant differences in age, race, BMI, or common comorbidities between the two groups. However, patients undergoing reconstruction were more likely to have:

More advanced American Society of Anesthesiologists (ASA) classifications (3 or 4, indicating significant or severe systemic disease)
Disseminated cancer
A higher calculated estimate of morbidity

Univariate analysis revealed that reconstruction was associated with an increased risk of several complications. After controlling for factors like age, BMI, anemia, diabetes, and tobacco use, reconstruction, disseminated cancer, and ASA classes 3 and 4 remained significant risk factors for readmission and any postoperative complication. Of these, reconstruction was the most significant predictor of readmission.

Moving Forward: Informed Decisions and Optimized Care

This study underscores the complexity of decisions surrounding vulvar reconstruction. While reconstruction can offer significant benefits in terms of restoring anatomy, function, and quality of life, it also carries increased risks of complications. The findings highlight the importance of careful patient selection, thorough preoperative optimization, and a collaborative approach between surgeons and patients to weigh the potential benefits against the risks. Further research, including long-term data on survival and quality of life, is needed to refine surgical techniques and improve outcomes for women undergoing vulvar reconstruction.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1097/igc.0000000000001332, Alternate LINK

Title: Trends And Complications Of Vulvar Reconstruction After Vulvectomy: A Study Of A Nationwide Cohort

Subject: Obstetrics and Gynecology

Journal: International Journal of Gynecologic Cancer

Publisher: BMJ

Authors: Alexandra L. Martin, J. Ryan Stewart, Harshitha Girithara-Gopalan, Jeremy T. Gaskins, Nicole J. Mcconnell, Erin E. Medlin

Published: 2018-10-01

Everything You Need To Know

What is vulvar reconstruction and why is it performed after a vulvectomy?

Vulvar reconstruction is a surgical procedure performed to restore the anatomy, function, and quality of life for patients who have undergone a vulvectomy. A vulvectomy, the surgical removal of vulvar tissue often necessitated by vulvar cancer or other vulvar conditions, can leave significant defects. Vulvar reconstruction uses various surgical techniques, including primary closure, skin flaps, and grafts, to address these defects. Though it may restore anatomy, function, and quality of life, studies suggest reconstruction may increase the risk of complications compared to primary closure.

What were the key findings of the study analyzing vulvar reconstruction after vulvectomy regarding complications?

The study analyzing vulvar reconstruction after vulvectomy, utilizing the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database, found that vulvar reconstruction was associated with an increased risk of complications. Specifically, reconstruction, disseminated cancer, and higher American Society of Anesthesiologists (ASA) classifications (3 and 4) were significant risk factors for readmission and any postoperative complication. Notably, reconstruction was identified as the most significant predictor of readmission.

What factors increase the risk of complications in vulvar reconstruction based on the study findings?

According to the study, undergoing vulvar reconstruction itself, having disseminated cancer, and having an American Society of Anesthesiologists (ASA) classification of 3 or 4 (indicating significant or severe systemic disease) are factors that significantly increase the risk of complications. These factors were identified as predictors for readmission and any postoperative complication. Of these, vulvar reconstruction had the highest correlation.

What does the study suggest about making decisions regarding vulvar reconstruction?

The study emphasizes the complexity of decisions surrounding vulvar reconstruction. It suggests the importance of careful patient selection, thorough preoperative optimization, and a collaborative approach between surgeons and patients. This approach ensures a careful weighing of the potential benefits of restoring anatomy, function, and quality of life against the increased risks of complications that the procedure carries. Further research including long-term data on survival and quality of life is needed.

How was the study on vulvar reconstruction conducted, and what data did it use?

The study was conducted using data from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database, which is a large repository of surgical data from hospitals across the United States. Researchers examined records from 2011 to 2015, focusing on patients who underwent vulvar excisions, both with and without reconstruction. The study compared patient characteristics, surgical procedures, and 30-day outcomes to identify potential risk factors and complications associated with reconstruction.