Wound complications following vulvar excision for non-malignant lesions

Abstract Background There is a paucity of literature regarding outcomes following vulvar excision for non-malignant lesions. This is a common procedure among gynecologists (GYN) and gynecologic oncologists (GO), and a body of evidence is warranted to guide clinical care and future research. Objectives This study aimed to estimate the rate of wound complications following simple vulvar excision and to identify risk factors for these outcomes. Our secondary objectives were to determine rates of 1) positive margins and 2) occult carcinoma in cases of vulvar dysplasia. Study design We conducted a single-institution, retrospective cohort study of patients who underwent simple vulvar excision procedures for suspected premalignant or benign lesions between June 2016 and February 2020. Our primary outcome was the rate of composite wound complication including wound separation or breakdown, infection, or hematoma. Our secondary outcomes were the incidence of 1) margins positive for residual dysplasia and 2) occult minimally invasive carcinoma. Fisher's exact tests and Chi-squared tests were used to compare categorical variables and logistic regression models and independent student t tests were used for continuous variables, as appropriate. Multivariate stepwise selection and multiple logistic regression was performed to evaluate risk factors for complication and generate odds ratios. Results Three-hundred thirty-eight patients were included and 143 (42.3%) experienced wound complication. The majority of these were wound separation or breakdown (n=134, 39.6%), followed by infection (n=22, 6.5%) and hematoma (n=4, 1.2%). On multivariate analysis, the presence of high-grade vulvar dysplasia (aOR 1.83, 95% CI 1.06-3.15), longer specimen diameter (aOR 1.03, 95% CI 1.01-1.05), and lesion location on the perineum (aOR 2.25, 95% CI 1.38-3.66) were independent risk factors. With high-grade vulvar dysplasia, the rate of positive margins was 50.2% (114/227) and occult microinvasive carcinoma was 17.2% (39/227). Notably the primary and secondary outcomes were similar between GO and GYN. Conclusions Wound complications following vulvar excision for non-malignant lesions are common. Select groups may benefit from anticipatory counseling and future interventional studies to prevent complication. The incidence of positive surgical margins and occult minimally invasive carcinoma is also high reflecting the challenging nature of treating vulvar disease.