1. 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

2. 2001 Zuk: Fatty tissue contains stemcells
2008 Rigotti: Effect of stemcells for radiation damaged tissure

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

4. 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

5. Lipotransplantion for lichen sclerosus randomized study in Aarhus, Denmark
Inklusion period :
Oct 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

6. 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.

7. Preparation: Sedimentation

8. 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.

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

10. 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 Dec.

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

12. 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

13. 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

14. 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

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

16. 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

17. 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 included in the lipo project – conventional terapy arm
6 mm biopsy : lichen planus

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