Incidence of vulvar cancer has been increasing by an average of 4.6% every 5 years, which caused 1200 deaths in 2018, and 6190 new cases are estimated to occur every year[4, 5]
The primary therapeutic approach to cure vulval malignancies is surgery, while subcutaneous effusion after the operation, which often induce infection and delayed healing of wound. Accordingly, many patients will still continue to suffer from persist lower extremity lymphedema in the future. Gould N found that early postoperative cellulitis (< 30 days after surgery) developed in 35.4%, early wound break- down in 19.4%, early lymphedema in 4.8%, and early lymphocyst formation in 13.1%. Late cellulitis (> 30 days after surgery) developed in 22.2%, late wound breakdown in 3.2%, late lymphedema in 29.5%, and late lymphocysts in 5%. The surgical treatment of vulvar cancer has evolved significantly over the past century to reduce the complication morbidity. Less radical modifications were formulated by Hacker, who promoted separate groin incisions in 1981, sparing the intervening skin bridge between the groins and the vulva, for groin node evaluations, the requirement to perform routine groin lymphadenectomies for all vulvar cancers was modified after findings from a 1987 GOG study, for tumors with > 1 mm invasion and that are up to 4 cm in size can be accomplished with either sentinel lymph node (SLN) biopsies, or IFLNDs, since two prospective multicenter studies, GOG 173 and GROINSS-V-1, have demonstrated the safety and feasibility of SLN mapping of the groin in vulvar cancer[15, 16].
There is no consensus in the literature on the association between the use of suction drainage and complications arising from groin node dissection. Gould et al found no association between duration of suction usage and complications, whereas Walker KF
et alfound that a short duration of use was associated with high rates of wound breakdown and a long duration of use was associated with higher rates of lymphedema, and recommend the use of subcuticular suture for wound closure. Pontre Jadvocated that Compared with patients in whom inguinal drains were placed, those in the ‘‘no drain’’ group had a significantly lower incidence of postoperative groin cellulitis (8.7% vs 25.4% P = 0.039). No significant differences were observed between patients in the “drain’’ and ‘‘no drain’’ groups in lymphocyst formation, wound infection, duration of hospital stay, and lower-limb lymphedema. However, our data show that Short-term lower extremity lymphedema occurred less frequency (31.6%) in the A group than B group (44.4%) (P > 0.05), also flap necrosis was observed in 10.5% groins for A group instead of 20.4% for B group (P < 0.01), and further incision infection happened more often in B group (29.6%) vs (7%). However, there was no statistical difference in acute cellulites, seroma, lymphocyst formation, or chronic lower extremity edma. It is worth mentioning that the occurrence rates of discomfort of drainage decreased by about 50% in our study(P < 0.05).
It is concluded from many research results that if negative drain was placed in the wound for patients with operation, multiple postoperative, especially incision complications will be relieved to a different extent .
This operative modality has been employed in our hospital since 2013, and negative drain without subcuticula suture was carried out in 57 groins by now. It is worth noting that there was an observable decrease in short-term complications, such as wound broke down, necrosis, infection as well as long-term complications including sense abnormity and pain.
Walker KFrecommended the use of a subcuticular continuous suture for skin closure which was recognized a lower risk of lymphocyst formation and lymphedema than the use of staples. However, we come to the opposite conclusion, since the manipulation of no subcutaneous suture contributed to not only flap well matched but also reduce flap tension, which relieved the wound broken, furthermore the negative drainage can facilitated tight fit between skin and deep tissue without cavity left, and then promote wound adhesion and the elimination of effusion, and at the same time a big difference was observed with the wound closing time. Carlson et al found an increased risk of short-term cellulitis with suction drain usage, but there was no significant difference between two groups on those aspects in our study, likely due to some methods performed on both groups as follows. First, the application of ultrasonic scalpel in inguinal lymph node dissection reduced the formation of two groups of lymphocysts. Secondly, the usage of staples reduced the inflammatory response of the flap. Furthermore, wound infrared ray therapy twice a day and vigorous care to keep the wounds clean and dry almost always result in adequate healing. Finally, the use of antibiotics postoperatively dramatically decreases the incidence of fever and acute cellulites. In a word, it can be concluded that the modified operative modality may facilitate the wound healing and decrease the postoperative complications.
With the combination of multiple treatment, such as: radiotherapy, chemotherapy, even target and imunotherapy, there is a promising trend toward a much conservative approach to curing the primary tumor and groin nodes [11, 12]. Still, Le A  found that the video endoscopic inguinal lymphadenectomy (VEIL) technique could effectively decrease the morbidity of groin node dissection. Nevertheless, the potential role of VEIL in decreasing the morbidity associated with complete inguinal-femoral lymphadenectomy, as well as its’ reliability needs to be further investigated, which is also underway in our hospital.