Lipotransplantation for Lichen sclerosus Mette Meinert, consultant,PhD, Helle Skyum,MD Tine Damsgård,consultant, PhD The Vulvar Clinic and Dept. of Plastic Surgery. Aarhus University Hospital

2001 Zuk: Fatty tissue contains stemcells 2008 Rigotti: Effect of stemcells for radiation damaged tissure

Local estrogen? Vaginal tablets (vagifem©, ovestin) Estrogen vaginal cream (ovestin©) Transdermal estrogen

DEFINITION Transplant: SYNONYMs Lipo transplantation Lipo filling Adipocytes stemcells adipose-derived adult stem (ADAS) cells SYNONYMs Lipo transplantation Lipo filling Fat transplantation Fat injection Lipo injection Nano fatfilling

Lipotransplantion for lichen sclerosus randomized study in Aarhus, Denmark Inklusion period : Oct 2013 - July 2016 20 women with lichen sclerosus randomization to Lipotransplantation or Conventional follow-up at the vulvar Clinic, Aarhus University Hospital 12months  offered active treatment

FAT-TRANSPLANT adipose-derived adult stem (ADAS) ADAS evolve into adipocytes, osteoblasts, condrocytes, endothelialceller. Direct transplant of ADAS into a niche and produce new adipocytes but also have a regenerative potential. Longtime effect: rejuvernation of the structure of the skin.

Preparation: Sedimentation

studies from Italy - Genova and Milano lipo-injection in combination with Platelet Rich Plasma (PRP) N= 15 ; Age (27-62) 4 months follow up: symptoms disappeared the anatomy i vulva was quite normal. Most diffucult cases need 2-3 treatments "New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration“. Casabona F et al. Plastic and reconstructive surgery 2012; 126:210.

2. Retrospective study: lichen sclerosus and fat grafting N = 36 with severe lichen sclerosus; 2011-2014. 10 pt excluded due to severe LS needing flap reconstruction Vulvar lichen sclerosus:Regenerative approach through fat grafting Boero V. Et alt. Gynecol Oncol. 2015 Dec.

method 1 procedure: 58 % - 3 procedures: 2 % (1 pt) Daysurgery in Local anestesia 1 plastic surgeon and 1 gynecologist 1 week rest Control 1,3,6 and 12 months follow up –mean:24 m Vulvar lichen sclerosus:Regenerative approach through fat grafting Boero V. Et alt. Gynecol Oncol. 2015 Dec.

Inclusion -Aarhus LS in the anogenital area Symptoms of ichting, burning and pain objective changes: lichenisation, fissures, scarring, synnechia.

Exclusion- Aarhus Age <18 and dementia Not able to fill out a questionaire and follow postoperative recommandations Suspecting vulva dysplasia or vulvacancer Previous reconstructive surgery Smoking

control group 6 mm punch biopsy at inclusion The vulvar clinic 3, 6 og 12 mdr. clobetasol or other active treatment All patients offered active treatment

Plastic surgery, Aarhus University hospital operation in general anaestesia in a day surgery setting Follow–up: 3 month postop and planning the next operation. Information about dilatation, clobetasol treatment

Restrictions No sitting on the recipient site for 14 days Compression on the donor site (abdomen) for 3 weeks ( day and night)

Half way status 21 lipotransplantations (most patients recieve 3 operations) No infections, haematomas and lesions to surrounding organs 1 fat necrosis of 1 x 0,5 cm (was removed) All patients up to now report bettering of symtoms

One case 63 year old 2014: Postmenopausal bleeding 12 years no intercourse due to burning og pain Vulva: red demarkeded areas in vestibulum synnekiae og hyperkeratosis in the perineum and perianal. the introitus may be Clobetasol with some effect but still no intercourse Sep. 2014 included in the lipo project – conventional terapy arm 6 mm biopsy : lichen planus

1. lipo. My right inner labium is back (!) I do not use clobetasol anymore Still no intercourse.