Abstract：
BACKGROUND: Lichen sclerosus et atrophicus is an inflammatory, scarring dermatosis of the female anogenital area and may lead to pain and sexual dysfunction. In select cases which are refractory to conservative therapy, surgery may provide significant symptom improvement. The objective of this study was to expand the range of surgical treatment options for these patients by presenting the operative outcomes of a specialised reconstructive method using the anterior obturator artery perforator (aOAP) flap.
METHODS: A retrospective cohort study was conducted on sexual outcomes following the excision of affected vulvovestibular tissue by skinning vulvectomy and subsequent single-stage reconstruction using the aOAP flap. Additional procedures, such as the Omega-Domed (OD) flap, scar surgery and clitoral re-exposure, were performed when indicated.
RESULTS: Between 2014 and 2022, a total of 61 patients were surgically treated and retrospectively included in this study. Vulvectomy and subsequent reconstruction with bilateral aOAP flaps were performed in 53 (87%) cases. There was a significant reduction in the prevalence of dyspareunia and inability to have sexual intercourse at the 1-year follow-up compared to baseline (p < 0.001). There were several minor, reversible complications that required secondary intervention.
CONCLUSIONS: The outcomes of this study indicate a substantial improvement in sexual function, evidenced by a significant reduction in dyspareunia and an increased ability to engage in sexual intercourse. Altered tissue quality in patients with lichen sclerosus et atrophicus and long-term cortisone application may predispose this patient population to a higher risk of minor post-operative complications.
BACKGROUND: DRKS00033261.
METHODS: A retrospective cohort study was conducted on sexual outcomes following the excision of affected vulvovestibular tissue by skinning vulvectomy and subsequent single-stage reconstruction using the aOAP flap. Additional procedures, such as the Omega-Domed (OD) flap, scar surgery and clitoral re-exposure, were performed when indicated.
RESULTS: Between 2014 and 2022, a total of 61 patients were surgically treated and retrospectively included in this study. Vulvectomy and subsequent reconstruction with bilateral aOAP flaps were performed in 53 (87%) cases. There was a significant reduction in the prevalence of dyspareunia and inability to have sexual intercourse at the 1-year follow-up compared to baseline (p < 0.001). There were several minor, reversible complications that required secondary intervention.
CONCLUSIONS: The outcomes of this study indicate a substantial improvement in sexual function, evidenced by a significant reduction in dyspareunia and an increased ability to engage in sexual intercourse. Altered tissue quality in patients with lichen sclerosus et atrophicus and long-term cortisone application may predispose this patient population to a higher risk of minor post-operative complications.
BACKGROUND: DRKS00033261.
摘要：
背景：硬化性苔藓是一种炎症性疾病，女性肛门生殖器区域的瘢痕性皮肤病，可能导致疼痛和性功能障碍。在保守治疗难以治疗的部分病例中，手术可以提供显著的症状改善。这项研究的目的是通过提供使用闭孔前动脉穿支（aOAP）皮瓣的专门重建方法的手术结果，扩大这些患者的手术治疗选择范围。
方法：采用aOAP皮瓣剥皮外阴切除术切除受影响的外阴前庭组织并随后进行单阶段重建后的性结局进行了回顾性队列研究。附加程序,如欧米茄圆顶（OD）皮瓣，疤痕手术和阴蒂再暴露，在指示时进行。
结果：在2014年至2022年之间，共有61例患者接受了手术治疗，并回顾性纳入本研究。53例（87％）进行了外阴切除术和随后的双侧aOAP皮瓣重建。与基线相比，在1年的随访中，性交困难和无法进行性交的患病率显着降低（p<0.001）。有几个未成年人，需要二次干预的可逆性并发症。
结论：这项研究的结果表明性功能有了实质性的改善，表现为性交困难的显着减少和进行性交的能力增强。硬化性苔藓和萎缩性苔藓患者的组织质量改变和长期使用可的松可能会使该患者人群发生轻微术后并发症的风险更高。
背景：DRKS00033261。
方法：采用aOAP皮瓣剥皮外阴切除术切除受影响的外阴前庭组织并随后进行单阶段重建后的性结局进行了回顾性队列研究。附加程序,如欧米茄圆顶（OD）皮瓣，疤痕手术和阴蒂再暴露，在指示时进行。
结果：在2014年至2022年之间，共有61例患者接受了手术治疗，并回顾性纳入本研究。53例（87％）进行了外阴切除术和随后的双侧aOAP皮瓣重建。与基线相比，在1年的随访中，性交困难和无法进行性交的患病率显着降低（p<0.001）。有几个未成年人，需要二次干预的可逆性并发症。
结论：这项研究的结果表明性功能有了实质性的改善，表现为性交困难的显着减少和进行性交的能力增强。硬化性苔藓和萎缩性苔藓患者的组织质量改变和长期使用可的松可能会使该患者人群发生轻微术后并发症的风险更高。
背景：DRKS00033261。
