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Modified Turnbull–Cutait anastomosis with fasciocutaneous flap reconstruction for radical excision of vulvar and anal intraepithelial neoplasia

  • A. C. RogersEmail author
  • M. Brophy
  • T. A. Walsh
  • R. P. Hanson
  • A. E. Brannigan
Trick of the Trade
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Introduction

Intraepithelial neoplasia of the lower genital tract, perineum and perianal area is most often linked to the prevalence of human papillomavirus (HPV) infection [1]. HPV predisposes to precancerous lesions involving the cervix, but less commonly the vagina, vulva and anus. Left untreated, anal intraepithelial neoplasia (AIN) and vulvar intraepithelial neoplasia (VIN) can progress to invasive cancer; with long-term progression of approximately 10% [2]; risk is highest in those who smoke, have multifocal disease or are immunocompromised [1].

Treatment strategies vary, and range from watchful waiting to radical excisional surgery, but irrespective of modality, up to 50% of patients will develop recurrence [3]. Recurrence is significantly lower with clear surgical margins [3], although lymph node clearance is not necessary.

In the current study, we report a novel therapeutic strategy for extensive multifocal high-grade intraepithelial neoplasia involving complete surgical...

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The patient gave full written and informed consent for her phase and photographs to be presented internationally and in publication form.

References

  1. 1.
    Fehr MK, Baumann M, Mueller M et al (2013) Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia. J Gynecol Oncol 24(3):236CrossRefGoogle Scholar
  2. 2.
    Scholefield JH, Harris D, Radcliffe A (2011) Guidelines for management of anal intraepithelial neoplasia. Colorectal Dis 13:3–10CrossRefGoogle Scholar
  3. 3.
    van Seters M, van Beurden M, de Craen AJ (2005) Is the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322 published patients. Gynecol Oncol 97(2):645–651CrossRefGoogle Scholar
  4. 4.
    Massad LS, Xie X, Darragh T et al (2011) Genital warts and vulvar intraepithelial neoplasia. Obstet Gynecol 118(4):831–839CrossRefGoogle Scholar
  5. 5.
    Simard EP (2010) Spectrum of cancer risk late after AIDS onset in the United States. Arch Intern Med 170(15):1337CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • A. C. Rogers
    • 1
    Email author
  • M. Brophy
    • 1
  • T. A. Walsh
    • 1
  • R. P. Hanson
    • 1
  • A. E. Brannigan
    • 1
  1. 1.Department of General and Colorectal SurgeryMater Misericordiae University HospitalDublin 7Ireland

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