Radical vulvectomy: Procedure

Radical vulvectomy with bilateral inguinal lymphadenectomy done through three separate incisions.
(A) Bilateral inguinofemoral lymphadenectomy through separate incisions is completed. Separate incision for radical vulvectomy is marked.
(B) Labiocrural incisions are extended to deep fascia of the urogenital diaphragm.
(C) Dissection proceeds dorsally off of the pubic bone. The vascular base of the clitoris is clamped, followed by transection and ligation.
(D) Perineal body and posterior vulvar tissues are dissected away from the anus.
(E) The vascular vestibular tissue along the sides of the vaginal tube is clamped. Transection and suture ligation to follow.
(F) Radical vulvectomy resection is completed.
(G) Closure of the vulvar wound is completed.