Vulvar lichen sclerosus: A new regenerative approach through fat grafting.
OBJECTIVE. The aim of this study was to evaluate the efficacy of fat grafting in the treatment of severe vulvar lichen sclerosus (LS). Our primary outcome was to assess the improvement of mucocutaneous trophism, the resolution/reduction of symptoms, and the histological features of the vulvar skin after treatment. The secondary outcome was to evaluate the improvement in life quality, and in resumption and quality of sexual life. METHODS. Between 2011 and 2014, 36 patients were offered fat grafting to treat LS. Inclusion criteria were age between 25 and 80 years, histopathologic diagnosis of LS, good health, failure of previous first line treatments. RESULTS. 34 out of 36 patients (94%) showed a better vulvar trophismof the skin and mucosae; 27 (75%) had an improvement in caliber and elasticity of the vaginal introitus; clitoris burying degree was reduced in 18 patients (50%), 30 (83%) reported an increased volume of labia major a and minor a, 34 (94%) had a complete disappearance of scratching lesions, and 28 (78%) showed a remission of white lesions. Eventually 34 patients (95%) stopped using topical corticosteroids routinely. The improvement in life quality was significant for both DLQI (p b 0001) and FSFI (p b 0001). CONCLUSIONS. Fat grafting may have a role as a support and completion treatment in selected cases of women with vulvar LS who do not respond to first line therapy or in severe cases where the anatomical impairment does not allow a regular sexual function and a good quality of life.
Department of Mother and Infant Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy. Electronic address: vboero@gmail.com.
Veronica
V
Boero
Plastic Surgery Unit, General Surgery Department, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Massimiliano
M
Brambilla
Department of Mother and Infant Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Elisa
E
Sipio
Department of Mother and Infant Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Carlo A
CA
Liverani
Department of Mother and Infant Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Mirella
M
Di Martino
Department of Mother and Infant Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Benedetta
B
Agnoli
Department of Mother and Infant Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Giada
G
Libutti
Division of Pathology, Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
F M
FM
Cribiù
Division of Pathology, Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Alessandro
A
Del Gobbo
Cell Factory, Unit for Cellular Therapy and Cryobiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, via Commenda 12, 20122, Italy.
Enrico
E
Ragni
Department of Mother and Infant Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, via Commenda 12, 20122, Italy.
Giorgio
G
Bolis
D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002987:Clitoris / Q000502:physiology; D004548:Elasticity / Q000502:physiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000502:physiology; D011788:Quality of Life; D012038:Regeneration; D019529:Sexuality; D012867:Skin / Q000473:pathology; D012879:Skin Physiological Phenomena; D014844:Vulva / Q000502:physiology*; D007724:Vulvar Lichen Sclerosus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
Fat grafting; Lichen sclerosus; Stem cells; Vulva