Surgical treatment of complications of vulvar lichen sclerosis

Management of patients with vulvar lichen sclerosis (VLS) in most cases involves conservative therapy. However, inadequate or no conservative therapy can lead to conditions requiring surgical intervention (suspected malignancy, functional impairment). Surgical treatment for VLS is associated with the risk of complications and the formation of wound defects, leading to cicatricial changes and a deterioration in quality of life. Objective. To analyze reconstructive surgeries performed in patients with various types of VLS requiring surgical treatment. Materials and methods. A single-center, consecutive series of observations included 17 patients with complications of VLS requiring surgical treatment (vulvar resection or vulvectomy with vulvar reconstruction). Postoperatively, sodium deoxyribonucleate was administered, and recommendations for supportive care were provided. Postoperative follow-up ranged from 6 months to 6 years. Results. The appearance of the external genitalia in patients with various types of VLS before and after surgical treatment and comprehensive anti-relapse therapy is described and presented in photographs. Surgical treatment of patients with VLS is indicated when conservative therapy is ineffective, differentiated vulvar intraepithelial neoplasia, cancer, functional impairment, and complications of previous interventions. In the case of the atrophic variant, surgery is required less frequently, primarily for stenosis and dysuria, and organ-preserving treatment is often possible. Sclerosing and scleroatrophic lichen sclerosis more often require vulvectomy followed by vulvectomy reconstruction. Conclusion. Surgical treatment is not a generally accepted treatment option for patients with lichen sclerosis. Indications for surgical intervention for lichen sclerosis include failure of conservative therapy, differentiated vulvar intraepithelial neoplasia, vulvar cancer, functional impairment, and complications from previous surgeries or photodynamic therapy. Patients with the atrophic variant of lichen sclerosis require surgery less frequently, while patients with the sclerosing and scleroatrophic variants typically require a more radical approach, including vulvectomy followed by vulvectomy reconstruction.