Comparative study of different incision types in inguinal lymphadenectomy: retrospective study

Abstract

Background: Inguinal lymphadenectomy has always been associated with a high complication rate, mostly related to wound healing. Objectives: We aimed at evaluating the skin excision vertical incision in lowering wound complication rate following inguinal lymphadenectomy. Patients and Methods: Patients underwent inguinal lymphadenectomy for malignant nodal metastasis at the National Cancer Institute, Cairo University, Egypt in the period from January 2017 to December 2020. According to the incision type, we divided them into three groups: Group 1: vertical with vertical skin ellipse (~4cm) excision. Group 2: vertical S-shaped without skin excision.Group 3: transverse incision. We compared the short-term outcome among these groups. Results: Seventy-eight patients included, 27 (34.6%) G1, 27 (34.6% G2), and 24 (30.8%) G3. Complications occurred in a total of 20 cases (25.6% ). Its rate was highest in G3 (37.5% of cases) and least in G1 (14.8%). Flap necrosis was a common serious complication. It least occurred in the G1 Group and most in the G3 Group. No statistical difference was noticed regarding the median operation time, postoperative hospital stay, and median duration before drain removal. Capsular rupture did not occur in G1 patients, occurred only in one case of G2 (3.7%) and 2 cases of G3 ( 8.3%). Despite being statistically insignificant it is very significant oncologically. Conclusions: Vertical elliptical skin wedge excision in inguinal lymphadenectomy provides better surgical field exposure. It avoids direct handling of the tumor; thus is more safe oncologically. It has the least flap necrosis rate among other incision types.

Keywords

• inguinal lymphadenectomy skin excision lymphedema
• cutaneous malignancy soft tissue sarcoma