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UWHC,UWMF,

Clinical Hub,Patient Education,Health and Nutrition Facts For You,Gynecology, Oncology

Vulvectomy Surgery (5927)

Vulvectomy Surgery (5927) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Gynecology, Oncology

5927










Vulvectomy Surgery

Date of Surgery: _____________________

Your Surgery:________________________

Surgeon: ____________________________




Before your clinic visit, please:

 Read this booklet
 Fill out a Power of Attorney for Health Care
form, if you wish.


Bring this booklet, your medicines, vitamins, and
herbal supplements, any medical records that have
been given to you, recent X-rays and test results to
your pre-surgery clinic visit.

First Day Surgery Unit (608) 265-8857

1




Welcome to University of Wisconsin Hospital and Clinics


Knowing what to expect is part of getting ready for surgery. This booklet helps
you to learn about:

Your Pre-Surgery Clinic Visit ................................................................................... 1
Getting Ready for Surgery ......................................................................................... 3
The Day of Surgery .................................................................................................... 6
After Surgery .............................................................................................................. 8
Home Care after Vulvectomy ..................................................................................11
Glossary....................................................................................................................13
Important Phone Numbers .......................................................................................14



What Is First Day Surgery (FDS)

FDS means that you come in the day of surgery and stay until you are ready to go
home. Most often, you do not go home the same day.

Your Pre-Surgery Clinic Visit

Members of the surgery team will meet with you to:
ξ Talk with you about surgery.
ξ Learn more about your health history.
ξ Do a physical exam.
ξ Complete lab tests, EKG, Chest X-ray, and other tests, if needed.

This clinic visit may last 2 – 4 hours or more. You will learn how to prepare for
surgery and what you can do to regain your strength.

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By law, we need to ask if you would like to complete an advance medical directive
(AMD). This is a Power of Attorney (POA) for Health Care or a Living Will.
This decision is up to you. A POA allows you to name a health care agent who
could speak for you if you were not able to do so. If you choose to complete an
AMD, you must be 18 or older and of sound mind. You have the choice to
complete the form or not.

If you choose to fill one out, complete it and have it signed and witnessed before
coming to surgery. There is not enough time to complete the forms that morning.
The two witnesses cannot be family members or UW Hospital staff. Exceptions
are chaplains, social workers, and volunteers. The person you name as your health
care agent may not be a witness. We suggest you choose a neighbor or friend for a
witness. If you need help to complete this form or have questions, call our Patient
Relations office at (608) 263-8009.

You may wish to have a member of the Spiritual Care Services visit while you
are in the hospital. We can arrange it for you or you can call (608) 263-8574.




What is a Vulvectomy?

The vulva is the outer part of the female genital area. It can be a site of cancer.
Cancer of the vulva can occur in women of any age. It is most common in women
over 60. Risk factors for this type of cancer include:
ξ Smoking, now or in the past.
ξ Taking steroids or other drugs that weaken the immune system.
ξ Sexually-transmitted diseases.


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Cancer of the vulva is diagnosed by doing a biopsy of the site. Surgery, radiation,
and chemotherapy are treatments that may be used. Your doctor will talk with you
about what is best for you. Your doctor will help you understand the balance
between keeping your sexual function and the need to remove all of the cancer.

You are going to have a vulvectomy.
Your labia majora and labia minora
(vaginal lips) will be removed or
partially removed along with the
nearby tissue. You may also have
lymph nodes removed from one or both
of your groins. The lymph nodes will
be tested to see if the cancer has spread.
During surgery, drains will be placed
near your groins to help drain lymph
fluid that may collect after surgery. If
these drains are not taken out before
you go home, your nurse will teach you
how to measure the amount of fluid
collected. They will also show you how
to care for your drain sites. The drains
will be removed when you return to see
the doctor in clinic.

Getting Ready for Surgery

The time of your surgery will be set the day before surgery. We
will call you at the number you gave us, sometime after 9:00 a.m.
the day before your surgery (on the Friday before a Monday
surgery). We will tell you when to arrive, where to go, and
answer questions.

Before this call, please review details your clinic or anesthesia staff gave you
during your clinic visit. If you do not hear from us by 3:00 pm, please call
(608) 265-8857. We do need to talk to you before your surgery. Tell us where you
will stay the night before surgery.

If you have a cold, fever, or illness before surgery, call your doctor’s clinic. After
hours or on weekends ask to speak with the anesthesia doctor on call.


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Steps for Getting Ready

1. Your doctor may ask you to stop taking pills that “thin” your blood. You may
need to stop these anywhere from 24 hours before surgery to 7 days before.
Ask your doctor when you should stop them. Blood thinners include:

ξ Aspirin, Excedrin , Ascriptin and Ecotrin
ξ Plavix
ξ Vitamins and herbal supplements
ξ Coumadin or warfarin
ξ Ibuprofen, Advil , Motrin , Nuprin , and Aleve

If you take any of the pills listed above or herbs, please let us know.

It is alright to use acetaminophen (Tylenol ) if you can normally take it.

2. You will need to stop all eating and drinking at midnight the night before
surgery. This includes no gum, candy, or tobacco. At your clinic visit, we
will tell you if you need to take any of your pills the morning before surgery.
Be sure to ask about this if you have questions or call the clinic if this was not
made clear to you.

3. Your surgeon may want you to take laxatives to empty stool from your bowel
before surgery. You will get details on the bowel prep at your clinic visit.

4. Do not drink alcohol after 8:00 pm the night before surgery. If mixed with
anesthesia, it can cause problems.

5. Try to stop smoking or at least cut back. It takes at least 3 days to rid your
body of carbon monoxide from cigarettes. If present in your body, it will
delay wound healing. It can also increase the risks from anesthesia. If you’d
like help quitting, call the Quit Line: 1-800-QUITNOW (784-8669).

6. Shower before surgery using the Hibiclens® soap. Use it the morning of your
surgery. You may get this soap during your clinic visit. First, shower with
your own soap. Any special beauty treatments you do, you may want to do
now as you may not be able to shower for a few days after surgery. Rinse.
Pour the Hibiclens® soap on a damp, clean washcloth or new shower sponge.
This thin soap tends to easily run down the drain. Scrub from your neck to

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your toes for 10 minutes. Rinse well. Do not use lotions, powder or perfumes.
If you do not get Hibiclens at your clinic visit, you can buy it at your local
drug store or you may be able to use other soap as instructed by your clinic.

7. Do not wear make-up. Please remove nail polish from at least one finger.

8. Try your best to have a restful night before surgery. If you are coming from
out of town, you may wish to stay in Madison. A Housing Accommodations
Coordinator, (608) 263-0315, can provide you with a list of nearby motels
and arrange for your stay at a discount rate.

9. The morning of surgery, brush your teeth and rinse, but do not swallow.

10. If you are taking pills, we will tell you during your clinic visit whether you
should take them the day of surgery. If you take them, swallow with just a sip
of water.




11. Please leave all jewelry, rings, large sums of money, and credit cards at home.
You will be asked to remove all jewelry. Please remove all body piercings.

12. Bring along inhalers, CPAP, glucose meter, eye glasses, eye drops, hearing
aids, dentures, prostheses, and other special equipment that you will need. Be
sure these items are labeled and in a case, if appropriate. Please do not bring
bottles of pills with you the morning of surgery unless you have been told to
do so. You will be asked to leave your glasses, teeth, and hearing aides with
your family before you go to surgery.

13. Please bring non-skid slippers or slip-on shoes and a few personal items. You
do not need to bring pajamas or a robe. You may want to bring a book or
something to do. TVs are in each room at no charge. Bring a calling card or
your cell phone if you wish to make long distance calls. You may bring in
your laptop; all of the rooms have patient internet access. Please have your
family member leave your belongings in the trunk of your car the day you
check in. Once your room is ready, they can bring your things to you. The
hospital is not responsible for theft of personal items.

If you have diabetes, you will be given details about your
insulin or oral pills at your clinic visit.

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14. Once you are home, it may take a few days or many weeks for you to get back
to your normal routines (work, child care, laundry, shopping). Make plans for
these changes. The length of time each person needs to recover varies. Plan to
talk about these details with us. You may need to make special plans before
surgery.

15. Stop at Admissions the day of your clinic visit. If you cannot to do this, you
may call them. Please call them as soon as you can to get your paper work
started. Your family will get one parking pass for the length of your stay. It
can be picked up the day of your surgery by your family.
Admissions is open 7 am to 9 pm. 608-263-8770

The Day of Surgery

The First Day Surgery (FDS) Unit is open 5:30 am to 6:00 pm. The Main Hospital
door is open at all times. Please check in at FDS at your scheduled time. Enter
using the Main Hospital door the day of your surgery. See map in the back.

After you arrive, a nurse will ask you questions about your health and help you get
ready. An anesthesia doctor will meet with you and answer questions. You will
have an IV (intravenous) placed in a vein of your hand or arm. An IV is used to
give fluids and medicine. You may be given medicine to help you relax. These
rooms are small. There may only be space for 2 family members or friends.

In the Operating Room

Your family may stay with you until you are taken to the
OR on a rolling cart. Once you are in the OR, your nurse
will answer questions, make sure you are comfortable,
and explain what is happening.

The staff wears masks, gowns, and hats. They will help
you move onto a narrow, firm bed. The nurse will place a
safety belt, like a seat belt, across your legs. They will
place ECG (electrocardiogram) patches on your chest, a blood pressure cuff on
your arm, and a plastic clip on your finger to check your heartbeat and oxygen
level. The anesthesiologist will ask you to breathe oxygen through a soft plastic
mask and medicine will be given to you through your IV. After you are asleep, a

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breathing tube will be placed in your windpipe to breathe for you. Other IVs and
monitors will be added after you are asleep.

A Note to Families

The amount of time your loved one spends in the operating room depends on the
type of surgery. You can wait in the Surgery Waiting Area (C5/2) on second floor.
If you have family that will be calling, please have them call (608) 263-8590. You
may want to bring along a book or something to do since the time may seem to
pass slowly. There is coffee, tea, reading materials, and a TV in this waiting area
from 7:00 am until 7:00 pm weekdays. If you wish to leave the waiting area,
please pick up a pager at the volunteer desk. The nurses will keep you informed
during surgery. After surgery, the surgeon will talk with you.






Recovery Room (Post-Anesthesia Care Unit)

After surgery, you will go to the Recovery Room. Here,
the nurses check you often. Most patients wear an
oxygen mask or tube under the nose. You will have a
tape or plastic clip on your finger, toe, or earlobe to
check your pulse and oxygen level in your blood. You
will have a blood pressure cuff on your arm. It will
tighten for a few seconds every 10-15 minutes as it
checks your blood pressure. If you feel cold, tell your
nurse. A heated blanket or lamp can be used to warm
you. You may hear beeps from the equipment.

Nausea and vomiting are common problems after surgery. If you are nauseated, let
your nurse know. Medicines can be given.
Sometime during the day, take your parking pass to the main hospital
information desk to have it stamped and to get one pass to be used
during your loved one’s stay.

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If you need to urinate, do not get out of bed. Call for help and the nurse will help
you. Some patients have a tube in the bladder to drain urine.

You may be in the recovery room an hour or longer. Family and friends are not
allowed in here. Once you are settled in your room, they may join you. You will
have your own room with your own bathroom. Some patients may go to an
Intensive Care Unit (ICU) for special care. The staff will tell your family and
friends about the visiting hours.

After Surgery

In your hospital room, your nurse will check on you often. You may have a few
tubes, drains and other equipment such as:

ξ An IV (intravenous line) in your hand or arm to provide fluids and
medicine until you are able to drink fluids well.

ξ A face mask or tube under your nose to give you oxygen.

ξ A plastic clip on your finger to check your oxygen level.

ξ A catheter to drain urine from your bladder. This tube continually drains
urine from your bladder. You may still have the urge to pass urine.

ξ An NG (nasogastric) tube in your nose to your stomach helps prevent
nausea and vomiting.

ξ Wound drains help you heal.

ξ Leg wraps inflate and deflate or elastic stockings to improve blood flow in
your legs.

A nurse will help you to understand how these items work and how long they will
be in place.

You may not be able to eat right after surgery. At first, you may get only ice chips.
As your body allows, your diet will progress from clear liquids (juice and broth) to
full liquids (milk or ice cream) to normal foods.

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Coughing and Deep Breathing

Once the breathing tube is out, nurses will ask you to breathe deeply, cough, and
use a breathing tool (incentive spirometer). Good breathing helps you to get rid of
the anesthesia and prevent pneumonia.

To cough and deep breathe

1. Place a pillow over your chest to lessen the pain while coughing.

2. Breathe in deeply and slowly through your nose. Hold it.

3. Exhale slowly through the mouth.

4. Repeat twice more.

5. Breathe in again; hold it, and then cough.

To use the incentive spirometer

1. Exhale and place your lips tightly around the mouthpiece.

2. Take a deep breath. Slowly raise the Flow
Rate Guide between the arrows.

3. Hold it. Continue to inhale, keeping the
guide as high as you can for as long as
you can, or as directed by your nurse or
respiratory therapist.

4. Exhale and relax. Remove the
mouthpiece and breathe out as usual.

5. Slowly, repeat 10-15 times each hour while you are awake.


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Pain Control

People used to believe that you had to put up with severe pain. This is not true.
We will work with you to prevent and relieve pain. Good pain control helps you

ξ Heal faster
ξ Leave the hospital sooner
ξ Prevent problems

Drug and non-drug treatments can help prevent and control pain. Do not worry
about getting “hooked” or “addicted” to pain pills. This is rare unless you already
have a problem with drug abuse.

For best results

1. Talk with your doctor and nurses about the choices you have. You and your
doctor can decide which is best for you.

2. Take (or ask for) pain medicine when pain first begins. Do not wait. Pain pills
take 20-30 minutes to work.

3. You will be asked to rate your pain using this scale.

0-10 Number Pain Intensity Scale
________________________________________________________________
0 1 2 3 4 5 6 7 8 9 10
No Mild Moderate Severe Worst
Pain Pain
Possible

4. The goal should be a level that will allow you to do your deep breathing
exercise, walk, and sleep with little pain. Rating your pain helps us to know
how well your pain medicines are working.

5. Tell the nurse or doctor about any pain that won’t go away. Don’t worry about
being a “bother”. Pain can sometimes be a sign of problems.

Pain medicine may cause you to become drowsy, dizzy, or lightheaded. Do not
drive, use machines, or drink alcohol while taking pain pills.


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Narcotics can cause constipation. When you go home, be sure to increase your
daily water or juice intake to 6-8 (8-ounce) glasses. Increase the fiber in your diet
as well.



Home Care after Vulvectomy

You must follow strict discharge instructions when you go home. Taking care of
your surgical site and watching for problems are vital to healing well.

A friend or family member should be present the day of discharge to hear
instructions. You will receive prescriptions for medicines. Please bring your
insurance card if you plan to fill these at the UWHC pharmacy.

Plan to leave by noon. A responsible person needs to drive you home and stay
with you for 24 hours. It may be helpful to have someone stay with you for the
first week or two after you go home. A case manager can help arrange for Home
Health, a nursing home stay, or Meals on Wheels, if needed.

Care of your surgical site

Each time you urinate or have a bowel movement, you must rinse with warm
water. Use the squirt bottle or sitz bath you were given in the hospital. It is vital to
wipe the site with caution to prevent any skin breakdown. After you have rinsed
well, you need to dry this area fully using a blow dryer. We suggest using a hair
dryer for at least 5-10 minutes on the cool setting. This is easiest to do if you are
lying down in bed. Your doctor may give you a white cream to use at home. Put
this cream on your perineum after each bladder or bowel movement. It is best to
put this cream on after the site is cleaned and dried well.

What to expect after surgery

ξ You may feel some pain at the surgical site.
ξ You may have some light, blood-tinged drainage for 1-2 weeks.
ξ If you were given a white cream to put on at home, this will create a light tan
discharge and may contain some sloughed skin.
ξ If you have staples in your groin, these will be removed in 12-14 days. This
will be done at your return to clinic visit.

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ξ If you had drains placed, you may clean the drain sites with mild soap and
water. Do this daily to prevent any infection. Most drains will be taken out
before you go home. If you go home with drains, your nurse will teach you
how to care for the drains. They will also show you how to measure the
drainage each day.
ξ You may have some mild swelling at the site.
ξ There will be sutures at the site. These will not be taken out before you go
home. They will dissolve slowly over time.

When to call the doctor

ξ If you have a fever of 100.4 θ F or higher.
ξ If you have swelling in your groin.
ξ If you have pain that does not go away with Tylenol , Advil , or the pain
medicine you were given when you left the hospital.
ξ If your incision pulls apart or breaks down.
ξ If your groin incisions become red or warm to the touch.
ξ If you have foul-smelling drainage.

How to reach us

To talk to a nurse, 8:00 am to 4:30 pm, Monday – Friday: (608) 263-7010.

After 4:30 pm, nights, weekends, and holidays, the above number will be answered
by the paging operator. Ask for the gynecology resident on call. Give them your
name and phone number with the area code. The doctor will call you back.

If you live out of the area, call 1-800-323-8942.


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Glossary

Biopsy: The removal of piece of tissue that is examined under a microscope to
check for cancer cells.

Chemotherapy: Treatment with anti-cancer drugs.

Labia Majora: The outer lips of the vulva.

Labia Minora: The inner lips of the vulva.

Lymph Fluid: The fluid that bathes the lymph nodes and may collect in spaces
where nodes have been removed.

Lymph Nodes: Small bean-shaped glands located throughout the body that filter
out and destroy bacteria and can collect cancer cells.

Perineum: The area between the anus and the vulva.

Radiation: High energy x-rays to pinpoint and destroy cancer cells in your body.

Vulva: The skin and tissue around the opening of the vagina, including outer and
inner lips and the clitoris.

Vulvectomy: Surgery that removes cancer by removing all or part of the vulva.


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Important Phone Numbers

Admissions and Insurance Advisors (608) 263-8770
(Financial Counselors) E5/213

Admissions Office (608) 263-9172
(Insurance Verification)

Business Office (608) 263-4466

General Billing Office (608) 262-2221

General Information (608) 263-6400

Gynecologic Oncology Clinic
Daytime hours 8:00 am to 5:00 pm (608) 263-7010
After hours, weekends and holidays (608) 262-0486
(ask for gynecological resident on call) 1-800-323-8942

Hospital Paging Operator (608) 262-0486

Housing Accommodations (608) 263-0315

Pastoral Care (608) 263-8574

Patient Information (608) 263-8590
(for room number and location)

Patient Relations Office (608) 263-8009

Pharmacy (608) 263-7025


Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor.
This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because
each person’s health needs are different, you should talk with your doctor or others on your health care team
when using this information. If you have an emergency, please call 911. Copyright © 7/2016 University of
Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5927

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Valet Parking is open 7:00 am to 7:00 pm. It is located between the clinic and
hospital doors.

To go to the Outpatient Surgery Center, enter at the clinic entrance. Once inside
the lobby, it’s the 1st door on your left

To go to the Ambulatory Procedure Center, enter at the hospital entrance.
Follow the gray path past the D elevator. Turn left when you see the APC sign.

To go to the First Day Surgery Unit, enter at the hospital entrance. Follow the
gray path to the D elevator. Take the D elevator to the 3rd floor and turn left to the
First Day Surgery Unit entrance.

This is the 2nd floor…
To get to the …

Cafeteria: H4/1 – H elevator to the 1st floor
ECG: F6/354 – F elevator to the 3rd floor
Pulmonary Function: E5/520 – E elevator to the 5th floor
Inpatient X-Ray: E3/3 – E elevators to the 3rd floor
Admissions – Behind the information desk