Using a #15C scalpel, I excised a butterfly-shaped piece of tissue, which was essentially the entire vulvar vestibule. This included some of the vagina from the vaginal introitus and part of the perineal body. I marked the specimen at 6oclock at the vaginal opening, as well as the right edge with two different colored sutures. Complete full-thickness skin excision was performed. I then obtained homeostasis with the Bovie electrocoagulator. A vaginal flap was going to be needed to close off this area. I then undermined the posterior vaginal wall with a Metzenbaum scissors and I advanced and dissected away the posterior vaginal wall from the underlying Denonvillers fascia and the rectovaginal space until i could easily mobilize full-thickness distal posterior vagina and stretch it to the perineal skin to be able to close this area of excision. Multiple layers were closed to close off any dead space. Approximately a 5-layer closure was performed to close off any dead space between the posterior vaginal wall and the Denonvilliers fascia. This also took the tension off the vaginal skin and perineal skin. Once the vagina was completely mobilized and the dead space was closed, I was able to re-approximate the vaginal mucosa on the introitus to the skin of the perineum. The corners of the ellipse toward the labia minora were closed with interrupted 3-0 vicryl on the cutting needle. The rest of the vaginal incision was closed in a subcuticular fashion.
Any help would be much appreciated!
Thank you
Jenny G