engleski

Inguinal-femoral lymphadenectomy in treatment of vulvar carcinoma.

Separate incision section is preformed in the shape of an ellipse. The incision is started 2 cm medial and 2 cm distal to the anterior superior iliac spine and ending 2 cm above and 2 cm medial from the pubic tubercle. Excision of the skin in the shape of an ellipse facilitates more complete dissection of inguinal lymph nodes and it reduces the degree of necrosis of the skin. The superficial inguinal lymph nodes are located immediately behind the Camper’s fascia. During the dissection of the superficial lymph nodes superficial circumflex-iliac vein and superficial epigastric vein are identified and ligated. The subcutaneous adipose tissue (along with the superficial lymph nodes) is grasped medially and distally to recognize the inguinal ligament. This is the upper surgical border of the dissection. Lateral surgical border is the fascia of sartorius muscle. The adipose tissue is then mobilized following distal surgical edge and the great saphenous vein is identified and ligated. In this region, accessory saphenous vein could be found and ligated. By dragging the grasped adipose tissue laterally and proximally we display the fascia of the adductor longus muscle as well as the fossa ovalis under the fascia cribrosa. The fascia cribrosa is carefully dissected with the ultrasonic knife and fossa ovalis is presented. Junction adventitia is separated by dissector to identify the femoral vein and sapheno-femoral junction. This is the place to coagulate the external pudendal arteries – the branches of the femoral artery and the proximally located superficial epigastric artery. The saphenous vein is then ligated at its point of entry into the femoral vein. Medial border of surgical dissection is the fascia of the rectus muscle and the falx of inguinal aponeurosis. By pulling the dissected subcutaneous tissue laterally we identify the femoral vein and artery and the femoral nerve (ventrolateraly) and the dissected tissue can be completely removed in a block. Dorsal surgical border of the dissection is the iliopectineal fascia. Distal border of the dissection is the apex of the femoral triangle, before the entrance of the Hunter’s canal. It is important to identify the entrance to the femoral canal, which is located medial to the femoral vein, in order to remove any residual Cloquet’s lymph node. After hemostasis is ensured the wound is closed in two layers (subcutaneous layer and skin) and the suction drainage is placed.

lymphadenectomy; lymph nodes; vulvar carcinoma

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