The Role of Nanofat Grafting in Vulvar Lichen Sclerosus: A Preliminary Report

Im ages Since the discovery of adipose-derived adult stem (ADAS) cells in adipose tissue [1], many studies have articulated a new concept of lipofilling, which is no longer seen as adipocyte grafting, but rather as stem cell transplantation. Tonnard et al. [2] proposed a new technique of fat grafting, known as nanofat grafting, which involves an emulsified suspension that can be injected in a more superficial plane through finer needles (27-gauge) than is possible in standard lipofilling. Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease of the anogenital area that often leads to significant impairments in sexual function and quality of life [3]. In this report, we present a case of advanced VLS treated with nanofat grafting in addition to standard lipofilling. The rationale of this approach was to take advantage of the regenerative capacities of ADAS cells to stimulate cellular growth and wound healing in lesions that do not show a tendency for spontaneous recovery. A 48-year-old woman with a history of VLS diagnosed 18 years previously complained of genital distortion making sexual intercourse completely impossible, decreased sexual desire, itching, burning, and soreness. The diagnosis of VLS was confirmed through histological examination. Topical treatments had unsatisfying results, and she suffered from ulcers and infections after every treatment with clobetasol. The patient presented with flattened labia majora, a complete agglutination of the labia minora, and a completely buried clitoris with a large sensation deficit. Additionally, she demonstrated an advanced stage of introitus sclerosis (Fig. 1). These problems led to anorgasmia and lack of sexual activity over the previous three years. Under general anaesthesia, we excised the scar tissue over the clitoris and released the adhesions between the clitoris and the hood. Once the clitoris was exposed, the periclitoral skin was sutured to prevent the early recurrence of phimosis. After liposuction and fat processing, we injected 40 mL of standard lipoaspirate into the labia majora and the clitoral area in a subdermal plane to restore the volume deficit. Following the Tonnard technique [2], we emulsified the lipoaspirate and injected 20 mL of nanofat around the introitus and the clitoris in the intradermal plane, using a 27-gauge needle. The patient’s informed consent was obtained to analyse a sample of 15 mL of nanofat in order to assess the isolation and proliferation of ADAS cells. The population of stem cells was composed of CD44+, CD90+, and CD105+ cells. When viewed under the fluorescence microscope and after staining with Sudan III, the morphology of the adipocytes was found to be normal (data not shown).