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


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...


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.


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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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