Perineal Post-related Vulvar Necrosis: A Rare Case Series and Review of Literature
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CASE REPORT
Perineal Post‑related Vulvar Necrosis: A Rare Case Series and Review of Literature Maitreyee Parulekar1 · Priyanka Honavar1 · Padmaja Samant1 Received: 11 July 2020 / Accepted: 6 October 2020 © Federation of Obstetric & Gynecological Societies of India 2020
Abstract Vulvar necrosis is a rare complication after lower limb fractures and hip surgeries either due to direct damage to internal pudendal artery or post-surgery ischemic necrosis due to use of a perineal post. We present a series of 3 cases post-orthopedic surgeries with vulvar necrosis. All three patients presented to us after history of orthopedic surgeries which used a perineal post intraoperatively. They developed vulvar edema and blackish discoloration 6–8 h after the orthopedic procedure and referred for further management. Traction post-related vulvar necrosis can have major psychological and functional consequences; hence, formulating measures for prevention and promptly diagnosing the condition and ensuring early management to maintain the functionality of vulva is of utmost importance. Abbreviations NSAIDs Non-steroidal anti-inflammatory drugs EUSOL Edinburgh University solution of lime
Introduction Perineal post is an important tool which is used in management of surgeries around the hip for traction purpose. Improper application of this traction could lead to rare complications of vulvar oedema and necrosis. This clinical presentation is often confusing and can present as a diagnostic dilemma to the treating gynaecologist. The current description of cases provides an overview of different clinical presentations and the treatment modalities that can be utilized during the management of this rare complication. Dr Maitreyee Parulekar is a Senior Resident, Department of Obstetrics and Gynaecology, Seth G.S Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India. Dr Priyanka Honavar is a Assistant Professor, Department of Obstetrics and Gynaecology, Seth G.S Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India. Dr Padmaja Samant is a Additional Professor, Department of Obstetrics and Gynaecology, Seth G.S Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India. * Maitreyee Parulekar [email protected] 1
Department of Obstetrics and Gynaecology, Seth G.S Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra 400012, India
Case Description Case 1 A 16-year-old unmarried girl presented to the orthopedic emergency department with motor vehicular accident and was diagnosed to have a left closed femur shaft fracture. She was operated for the same by closed reduction, internal fixation with nail osteosynthesis on a traction table with perineal post under regional anesthesia, and the intraoperative course was uneventful. A gynecology reference was sent 8 h post-procedure for blackish discoloration and swelling of the vulva. Concomitant history of perineal trauma was ruled out. There were no medical comorbidities and no gynecological complaints prior to the surgery. On examination, ther
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