Fat Grafting in Vulvar Lichen Sclerosus: Long Term Follow-Up

Author:

Boero Veronica1ORCID,Brambilla Massimiliano2,Di Loreto Eugenia1,Cetera Giulia Emily1,Cipriani Sonia3,Boggio Francesca4,Monti Ermelinda1,Libutti Giada1,Caia Carlotta1,Parazzini Fabio

Affiliation:

1. Gynecology Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico Milano, Milan, Italy

2. Plastic Surgery Service, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico Milano, Milan, Italy

3. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

4. Department of Pathology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico Milano, Milan, Italy

Abstract

Objective The rationale for the use of autologous fat grafting in the treatment of vulvar lichen sclerosus (VLS) consists in reduction of inflammation, regeneration of tissues, volume increase, and pain fiber control. The main outcome of this study was the evaluation of patients' satisfaction after treatment. Secondary outcomes included modifications in symptoms, psychosexual wellbeing, vulvar hydration, and histology after surgery. Methods Eligible for this study were women aged 18–85 years with a histological diagnosis of VLS who underwent at least one autologous vulvar fat grafting at the authors’ center, between 2010 and 2019. In 2021, all women underwent a clinical reevaluation, comprehensive of vulvoscopy, vulvar biopsy, and handing out of validated questionnaires. Results Overall, 88.7% of patients declared themselves very satisfied/satisfied with the procedure. All symptoms were improved postsurgery; in particular, the difference was statistically significant for pruritus, burning, and dyspareunia (p < .05). Sexual function was also improved at time of reevaluation, as were depressive and anxiety symptoms (p < .05). No cases of vulvar intraepithelial neoplasia or cancer occurred during follow-up and vulvar architecture remained stable, although patients reported a significantly reduced need for topical steroids (p < .0001). Lastly, in postoperative biopsies, inflammatory infiltrate was stable or reduced, and the distribution of elastic fibers was comparable or restored in most patients. Conclusions Patient satisfaction with fat grafting is detectable up to 11 years after surgery, and as such, it may represent a valid therapeutic option in selected cases of VLS.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Obstetrics and Gynecology,General Medicine

Reference29 articles.

1. Vulvar lichen sclerosus: current perspectives;Int J Womens Health,2020

2. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018;Br J Dermatol,2018

3. Reduction in ERRα is associated with lichen sclerosus and vulvar squamous cell carcinoma;Gynecol Oncol,2015

4. Study of Langerhans cells and T lymphocytes in vulvar lichen sclerosus lesions;Australas J Dermatol,2021

5. British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010;Br J Dermatol,2010

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