A 42-year-old female patient, married, single-skinned, with a 20-year history of recurrent infections in the genital area.
At the age of 22 she contracted HPV; for years she was treated with laser without success.
C. albicans infections occurred at least once a month.
At the age of 34 she suffered from genital herpes.
Candidiasis episodes got worse, alternating with herpes.
Constant vaginal pain made it impossible for you to keep a regular sexual activity.
At 36 years of age, she underwent in vitro fertilization treatment (IVF), resulting in a twin pregnancy that was completed.
At 38 years of age, she underwent a new vaginal laser cauterization, which resulted in repeated ulcerations, mainly in two locations, always very difficult to heal.
She had a dry vagina permanently and could not use pants for constant pain.
Dissatisfaction caused by conventional and unsuccessful treatments, with their intimate life at an unacceptable level, the patient sought another alternative.
Taking into account the acquired knowledge about the treatment of wounds and the good evolution of chronic ulcers treated with liposuction graft (which contains most of the FEV and ADSCs (1)), we proposed an innovative solution to this problem.
This proposal consisted of:
1.
Resection of vaginal areas with repeated wounds and coverage with local rotation flaps.
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2.
Lipoinjection into the labia majora to increase its volume and thereby close the vulvar orifice and reticulate natural humidity.
3.
Lipoinjection is placed below the vaginal mucosa throughout its posterior hemisphere, seeking to increase the capacity of inflammatory response, improve the healing power and resistance to tissues.
Once the patient accepted the proposal, the surgery was performed with prior programming and under general anesthesia.
Although the fat donor areas with the highest production of stem cells are the body (3), in this case we chose to aspirate the hip using the tumescent technique with physiological serum from the trunk (4) usual practice /500,000 hips.
For liposuction we used cannulas of 4 mm in diameter and 3 mm for the graft.
From the aspirate column (about 400 cc).
Fig. 1), after waiting for 40 minutes for sedimentation, we disregarded the oil layer of the surface, resulting from the rupture of adipocytes, and the residual fluid of the fundus, product of the sealant.
Injection was achieved in 10 cc of fat in each labia majora, tunneled in layers, and 4 cc in the posterior submucosa of the vagina using a retroinjection technique, followed by a transverse approach.
The patient was discharged the day after the intervention.
She removed two internal suture stitches of polyglycolic acid at three and four weeks.
1.
As for recovery, her professional activities challenged three days after surgery, her sports activities at three weeks and, for fear, did not resume sexual relations until two months.
By restriction of the perineum, he presented a small fissure next to the posterior vaginal commissure after sexual intercourse, which he he healed rapidly.
1.
So far, after 9 months of follow-up, she has not had any recurrence of herpes or other type of infection; she has permanent humidity of the vagina, an aspect she was unaware of since she had always lived with local dryness.
The vaginal introitus is kept closed, the labia majora present a juvenile and turgid appearance and the patient can use any type of clothing.
Its only complaints are related to the occasional appearance of fissures in the posterior commissure after sexual act, and a small wound of 3 X 1 cm, painful, which occasionally appears at the point where laser suture was not previously irreconcilable.
These problems are caused by mechanical action and are susceptible to correction; they are due to a small excess in the closure of the perineum and to a reaction to suture thread, and not due to the lack of fully stabilized resistance of the material.
After this period, the critical moment for this type of surgery is considered overcome.
