Purpose:
Vulvar pressure injury associated hematoma and necrosis, is a rare complication after lower limb fracture surgery. There’s few articles with limit cases in literatures in the past, and none published in Taiwan. The cause either due to vascular injury, traction table and surgery technique associated trauma, inadequate perineal post protection. The treatment of such extensive pressure injury is challenging for both gynecologist and plastic surgeon.

Materials and Methods:
We present single case of post-femoral fracture surgery, presented with vulvar hematoma and necrosis. The patient underwent conservative wound management and hyperbaric oxygen therapy, resulted in labia minora hypertrophy and asymmetry at three months follow-up. Labiaplasty was performed due to refractory discomforts, including urine-spraying, vulvar prolapse, dysmenorrhea, sexual dysfunction. Patient was satisfied with final result, all discomforts diminished soon after procedure.

Conclusions:
Traction table related perineal complications are rare with grave functional and psychological consequences and can present as a diagnostic dilemma for surgeon. Preventive measures and standard management protocols are of critical importance to maintain maximum functionality of the vulva and offer favorable long-term outcomes.

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