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Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps

Year 2013, Volume: 18 Issue: 3, 145 - 149, 02.10.2013

Abstract

Abstract. Lichen sclerosus (LS) is a lymphocyte-mediated, chronic, inflammatory dermatitis which most commonly involves the anogenital area. Treatment options include topical corticosteroids, tacrolimus, carbon dioxide laser ablation and, as a last resort vulvectomy. The objective of this study is to report a refractory anogenital LS case and describe the use of a V-Y advancement flap for reconstruction of the perineal defect after vulvectomy.

A case of persistent LS, treated succesfully with surgery is presented and the literature is reviewed. The patient tolerated the surgical procedure well and a satisfactory cosmetic result was obtained.

A multidisciplinary team is ideal in the management of patients with persistent LS. Surgical management of LS should be reserved as a last resort for patients who are refractory to other medical treatment options and, in the case of a surgical attempt, techniques for reconstruction of the vulva should be well known.

Key words: Lichen sclerosus, vulvectomy, vulvar reconstruction

References

  • Val I, Almeida G. An overview of lichen sclerosus. Clin Obstet Gynecol 2005; 48: 808-817.
  • Meyrick Thomas RH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus et atrophicus and autoimmunity--a study of 350 women. Br J Dermatol 1988; 118: 41-46.
  • Ridley CM. Vulvar diseases. Dermatol Clin 1992; 10: 309-318.
  • UpToDate [database online version 19.2] Stewart EG, Barbieri RL, Dellavalle RP, Ofori O. Vulvar lichen sclerosus; 2011. In: www.uptodate.com, updated February 7, 2011.
  • Goldstein AT, Marinoff SC, Christopher K, Srodon M. Prevalence of vulvar lichen sclerosus in a general gynecology practice. J Reprod Med 2005; 50: 4774
  • Knol AC, Hage JJ. The infragluteal skin flap: a new option for reconstruction in the perineogenital area. Plast Reconstr Surg 1997; 99(7):1954-1959.
  • Hashimoto I, Nakanishi H, Nagae H, Harada H, Sedo H. The gluteal-fold flap for vulvar and buttock reconstruction: anatomic study and adjustment of flap volume. Plast Reconstr Surg 2001; 108: 1998200
  • McCraw JB, Massey FM, Shanklin KD, Horton CE. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg 1976; 58: 176-183.
  • Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999; 353: 1777-1783. van Seters M, van Beurden M, de Craen AJ. Is the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322 published patients. Gynecol Oncol 2005; 97: 645-651.
  • Neill SM, Lewis FM, Tatnall FM, Cox NH; British Association of Dermatologists. British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010. Br J Dermatol 2010; 163: 672-6
  • Jones RW, Scurry J, Neill S, MacLean AB. Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics. Am J Obstet Gynecol 2008; 198: 1-3.
  • Bracco GL, Carli P, Sonni L,et al. Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation. J Reprod Med 1993; 38: 37-40.
  • Neill SM, Tatnall FM, Cox NH; British Association of Dermatologists. Guidelines for the management of lichen sclerosus. Br J Dermatol 2002; 147: 6406
  • ACOG Practice Bulletin No. 93: diagnosis and management of vulvar skin disorders. Obstet Gynecol 2008; 111: 1243-1253.
  • Dalziel KL, Millard PR, Wojnarowska F. The treatment of vulval lichen sclerosus with a very potent topical steroid(clobetasol propionate 0.05%) cream. Br J Dermatol 1991; 124: 461-464.
  • Dalziel KL, Wojnarowska F. Long-term control of vulval lichen sclerosus after treatment with a potent topical steroid cream. J Reprod Med 1993; 38: 25
  • Cattaneo A, Carli P, De Marco A,et al. Testosterone maintenance therapy. Effects on vulvar lichen sclerosus treated with clobetasol propionate. J Reprod Med 1996; 41: 99-102.
  • Bousema MT, Romppanen U, Geiger JM,et al. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebocontrolled study. J Am Acad Dermatol 1994; 30: 225-2
  • Hengge UR, Krause W, Hofmann H, et al. Multicentre, phase II trial on the safety and efficacy of topical tacrolimus ointment for the treatment of lichen sclerosus. Br J Dermatol 2006; 155: 102110
  • Ridley CM. Lichen sclerosus et atrophicus. Br Med J (Clin Res Ed) 1987; 295: 1295-1296.
  • Abramov Y, Elchalal U, Abramov D, Goldfarb A, Schenker JG. Surgical treatment of vulvar lichen sclerosus: a review. Obstet Gynecol Surv 1996; 51: 193-1
  • Miller NF, Riley GM, Stanley M. Leukoplakia of the vulva. Am J Obstet Gynecol 1964; 64: 768-777.
  • Gurumurthy M, Morah N, Gioffre G, Cruickshank ME. The surgical management of complications of vulval lichen sclerosus. Eur J Obstet Gynecol Reprod Biol 2012; 162: 79-82.
  • Rouzier R, Haddad B, Deyrolle C, et al. Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol 2002; 186: 49-52.
  • Pérez-López FR, Ceasu I, Depypere H, et al. EMAS clinical guide: Vulvar lichen sclerosus in peri and postmenopausal women. Maturitas 2013 Jan 3. doi:pii: S0378-5122(12)00406-00409.
Year 2013, Volume: 18 Issue: 3, 145 - 149, 02.10.2013

Abstract

References

  • Val I, Almeida G. An overview of lichen sclerosus. Clin Obstet Gynecol 2005; 48: 808-817.
  • Meyrick Thomas RH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus et atrophicus and autoimmunity--a study of 350 women. Br J Dermatol 1988; 118: 41-46.
  • Ridley CM. Vulvar diseases. Dermatol Clin 1992; 10: 309-318.
  • UpToDate [database online version 19.2] Stewart EG, Barbieri RL, Dellavalle RP, Ofori O. Vulvar lichen sclerosus; 2011. In: www.uptodate.com, updated February 7, 2011.
  • Goldstein AT, Marinoff SC, Christopher K, Srodon M. Prevalence of vulvar lichen sclerosus in a general gynecology practice. J Reprod Med 2005; 50: 4774
  • Knol AC, Hage JJ. The infragluteal skin flap: a new option for reconstruction in the perineogenital area. Plast Reconstr Surg 1997; 99(7):1954-1959.
  • Hashimoto I, Nakanishi H, Nagae H, Harada H, Sedo H. The gluteal-fold flap for vulvar and buttock reconstruction: anatomic study and adjustment of flap volume. Plast Reconstr Surg 2001; 108: 1998200
  • McCraw JB, Massey FM, Shanklin KD, Horton CE. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg 1976; 58: 176-183.
  • Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999; 353: 1777-1783. van Seters M, van Beurden M, de Craen AJ. Is the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322 published patients. Gynecol Oncol 2005; 97: 645-651.
  • Neill SM, Lewis FM, Tatnall FM, Cox NH; British Association of Dermatologists. British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010. Br J Dermatol 2010; 163: 672-6
  • Jones RW, Scurry J, Neill S, MacLean AB. Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics. Am J Obstet Gynecol 2008; 198: 1-3.
  • Bracco GL, Carli P, Sonni L,et al. Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation. J Reprod Med 1993; 38: 37-40.
  • Neill SM, Tatnall FM, Cox NH; British Association of Dermatologists. Guidelines for the management of lichen sclerosus. Br J Dermatol 2002; 147: 6406
  • ACOG Practice Bulletin No. 93: diagnosis and management of vulvar skin disorders. Obstet Gynecol 2008; 111: 1243-1253.
  • Dalziel KL, Millard PR, Wojnarowska F. The treatment of vulval lichen sclerosus with a very potent topical steroid(clobetasol propionate 0.05%) cream. Br J Dermatol 1991; 124: 461-464.
  • Dalziel KL, Wojnarowska F. Long-term control of vulval lichen sclerosus after treatment with a potent topical steroid cream. J Reprod Med 1993; 38: 25
  • Cattaneo A, Carli P, De Marco A,et al. Testosterone maintenance therapy. Effects on vulvar lichen sclerosus treated with clobetasol propionate. J Reprod Med 1996; 41: 99-102.
  • Bousema MT, Romppanen U, Geiger JM,et al. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebocontrolled study. J Am Acad Dermatol 1994; 30: 225-2
  • Hengge UR, Krause W, Hofmann H, et al. Multicentre, phase II trial on the safety and efficacy of topical tacrolimus ointment for the treatment of lichen sclerosus. Br J Dermatol 2006; 155: 102110
  • Ridley CM. Lichen sclerosus et atrophicus. Br Med J (Clin Res Ed) 1987; 295: 1295-1296.
  • Abramov Y, Elchalal U, Abramov D, Goldfarb A, Schenker JG. Surgical treatment of vulvar lichen sclerosus: a review. Obstet Gynecol Surv 1996; 51: 193-1
  • Miller NF, Riley GM, Stanley M. Leukoplakia of the vulva. Am J Obstet Gynecol 1964; 64: 768-777.
  • Gurumurthy M, Morah N, Gioffre G, Cruickshank ME. The surgical management of complications of vulval lichen sclerosus. Eur J Obstet Gynecol Reprod Biol 2012; 162: 79-82.
  • Rouzier R, Haddad B, Deyrolle C, et al. Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol 2002; 186: 49-52.
  • Pérez-López FR, Ceasu I, Depypere H, et al. EMAS clinical guide: Vulvar lichen sclerosus in peri and postmenopausal women. Maturitas 2013 Jan 3. doi:pii: S0378-5122(12)00406-00409.
There are 25 citations in total.

Details

Primary Language English
Journal Section Case Report
Authors

Cihangir Mutlu Ercan

Mufit Cemal Yenen This is me

Murat Dede This is me

Mustafa Deveci This is me

Mustafa Ulubay This is me

İbrahim Alanbay This is me

Hakan Coksuer This is me

Publication Date October 2, 2013
Published in Issue Year 2013 Volume: 18 Issue: 3

Cite

APA Ercan, C. M., Yenen, M. C., Dede, M., Deveci, M., et al. (2013). Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps. EASTERN JOURNAL OF MEDICINE, 18(3), 145-149.
AMA Ercan CM, Yenen MC, Dede M, Deveci M, Ulubay M, Alanbay İ, Coksuer H. Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps. EASTERN JOURNAL OF MEDICINE. October 2013;18(3):145-149.
Chicago Ercan, Cihangir Mutlu, Mufit Cemal Yenen, Murat Dede, Mustafa Deveci, Mustafa Ulubay, İbrahim Alanbay, and Hakan Coksuer. “Surgical Management of a Persistent Lichen Sclerosus Case and Reconstruction of Vulva With Free Rotation and V-Y Advancement Flaps”. EASTERN JOURNAL OF MEDICINE 18, no. 3 (October 2013): 145-49.
EndNote Ercan CM, Yenen MC, Dede M, Deveci M, Ulubay M, Alanbay İ, Coksuer H (October 1, 2013) Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps. EASTERN JOURNAL OF MEDICINE 18 3 145–149.
IEEE C. M. Ercan, “Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps”, EASTERN JOURNAL OF MEDICINE, vol. 18, no. 3, pp. 145–149, 2013.
ISNAD Ercan, Cihangir Mutlu et al. “Surgical Management of a Persistent Lichen Sclerosus Case and Reconstruction of Vulva With Free Rotation and V-Y Advancement Flaps”. EASTERN JOURNAL OF MEDICINE 18/3 (October 2013), 145-149.
JAMA Ercan CM, Yenen MC, Dede M, Deveci M, Ulubay M, Alanbay İ, Coksuer H. Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps. EASTERN JOURNAL OF MEDICINE. 2013;18:145–149.
MLA Ercan, Cihangir Mutlu et al. “Surgical Management of a Persistent Lichen Sclerosus Case and Reconstruction of Vulva With Free Rotation and V-Y Advancement Flaps”. EASTERN JOURNAL OF MEDICINE, vol. 18, no. 3, 2013, pp. 145-9.
Vancouver Ercan CM, Yenen MC, Dede M, Deveci M, Ulubay M, Alanbay İ, Coksuer H. Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps. EASTERN JOURNAL OF MEDICINE. 2013;18(3):145-9.