vulvectomy
(vŭl-vĕk'tō-mē 
)
[‵ + Gr. ektome, excision]
Excision of the vulva, used to manage cancers of the vulva. Surgical approaches depend on the extent of the disease. They range from simple vulvar excision (for small, confined lesions with no lymph node involvement) to radical vulvectomy with bilateral superficial and deep inguinal node dissection. If metastasis is extensive, resection may include the urethra, vagina, and rectum. Plastic surgery, including pelvic area reconstruction via a mucocutaneous graft may be carried out at a later date.
SEE: vulvar cancer. .
Patient Care: The caregiver provides emotional support, encourages questions, and answers them. Preoperative: Care includes skin preparation, teaching about postoperative care (pain management, pulmonary hygiene, and venous stasis prevention) administration of prophylactic medications to prevent infection, and insertion of an indwelling catheter. The nurse encourages the woman to express her anxieties, fears, and concerns; validates her understand ing of the procedure and its implications (change in body image and alterations in sexual function); and witnesses her informed consent. Postoperative: Care includes cleansing the wound with diluted hydrogen peroxide, rinsing with normal saline, and drying with a heat lamp, a cool-air hair dryer, or exposure to the air three or more times daily as ordered. The wound must be observed closely for evidence of occult bleeding or infection. The caregiver positions, and frequently repositions the woman for comfort using special mattresses, bed cradles, and trapeze to aid self-movement and administers analgesics as needed and prescribed. Patient-controlled analgesia (epidural or intravenous) are appropriate for the early post-operative period. Deep breathing using an inspirometer and coughing are encouraged. Antiembolic hose or pneumatic pump dressings are applied. Nourishment and hydration is provided by intravenous route until oral fluid and solids are tolerated. Antidiarrheal drugs are administered as needed. Wounds are cleansed to prevent infection. Stool softeners and a low-residue diet may be appropriate as the patient progresses. Depending on the extent of the procedure, home health care is arranged. Discharge teaching emphasizes care of the wound and catheter. The patient is advised to report bleeding, purulent discharge, or intolerable pain to the primary caregiver. After a simple vulvectomy, sexual intercourse may resume when the wound has healed (about 6 to 8 wk after surgery). Adjuvant postoperative treatments may include chemotherapy with or without radiation therapy. Irradiation may be used for palliative care if advanced age, poor health, extensive metastasis, or patient preference rules out surgical treatment.