Anterior obturator artery perforator (aOAP) flap: A last-resort treatment option for sexual dysfunction in lichen sclerosus et atrophicus

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 95; pp. 331 - 339
• Main Authors: O’Dey, DM, Rosendahl, M, Mordehay, D, Kameh Khosh, M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2024
• Subjects: Adult; Aged; aOAP flap; Dyspareunia; Female; Humans; Lichen; Lichen Sclerosus et Atrophicus - complications; Lichen Sclerosus et Atrophicus - surgery; Middle Aged; Perforator Flap - blood supply; Plastic Surgery Procedures - methods; Retrospective Studies; Sexual dysfunction; Sexual Dysfunction, Physiological - etiology; Surgery; Treatment Outcome; Vulva - surgery; Vulvectomy - methods; Dyspareunia; Lichen; Sexual dysfunction; Surgery; aOAP flap
• ISSN: 1748-6815; 1878-0539; 1878-0539
• DOI: 10.1016/j.bjps.2024.05.046

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. 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. 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. 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. DRKS00033261