Surgicel in the management of labial and clitoral hood adhesions in adolescents with lichen sclerosus.
OBJECTIVE
Lichen sclerosus (LS) is an inflammatory dermatosis of the vulva with potentially destructive consequences to the young woman's perineum. Long-term sequelae include atrophy of the labia minora, scarring of the clitoral hood, and labial and/or clitoral hood adhesions. This study aims to find techniques for preventing these devastating effects.


METHODS
Three young women, ages 14 and 15 years, with a long history of lichen sclerosus and labial adhesions, presented with recurrent labial and periclitoral adhesions. Increasing pain prior to presentation, exquisite enough to inhibit even walking, necessitated urgent operative intervention. Scarring of the clitoral hood with an area of firmness beneath the scarring was present. Sharp dissection of the clitoral hood was performed with the entrapped keratinaceous debris and hair expressed. The adherent labia were separated. Surgicel, oxidized regenerated cellulose gauze (Johnson & Johnson, Arlington, TX), was sutured to the exposed clitoral hood and labial surfaces with vicryl suture. Complete dissolution of the Surgicel occurred between postoperative day 4-6 without recurrence of adhesions. One-year follow-up did not reveal any evidence of recurrence in any of the three patients.


CONCLUSIONS
The recurrence of labial and clitoral hood adhesions in young women with a history of LS was prevented for at least 1 year by surgical lysis and application of Surgicel to the affected area. This technique has prevented the recurrence during the interval when these surfaces are at highest risk of re-agglutination.
Breech
L L
LL
Department of Obstetrics and Gynecology, Division of Gynecology, Washington University, St. Louis, MO, USA.
Laufer
M R
MR
D000293:Adolescent; D002483:Cellulose, Oxidized / Q000627:therapeutic use*; D002987:Clitoris / Q000601:surgery; D005260:Female; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D007724:Vulvar Lichen Sclerosus / Q000209:etiology / Q000601:surgery*
D002483:Cellulose, Oxidized; C013695:Surgicel