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首页> 外文期刊>Aesthetic plastic surgery >Labia majora labioplasty in HIV-related vaginal lipodystrophy: Technique description and literature review
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Labia majora labioplasty in HIV-related vaginal lipodystrophy: Technique description and literature review

机译：HIV相关的阴道脂肪营养不良的大阴唇阴唇成形术：技术描述和文献综述

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Background: We present a rare case involving severe hypertrophy of the labia majora. This 39-year-old married woman developed a clinically noticeable bilateral lipodystrophy of her labia majora following the administration of chronic antiretroviral therapy. Different combination drug regimens that included drugs like Crixivan?, Epivir?, and Zerit? were administered to the patient from 1998 to 2005. The patient is currently on a single drug regimen of Atripla? with the disease under control and no other comorbidities. The severity of the pubic protuberance created an appearance resembling male genitalia, even when covered by underwear. This anatomical abnormality obviously impaired her social life and forced her to avoid wearing tight pants, swimming garments, and tight clothes in general. She also avoided any sexual activity. Methods: Her pubic hair was shaved. Crural creases and vulvar mucosa were marked in order not to be violated. The estimated amount of skin and fat to be removed was marked. Intraoperative tailor-tacking suturing was used to mark the extent of the resection of the labia majora. Sutures were left in place to verify the accurate tension of the remaining skin. The procedure was performed with the patient under general anesthesia. Labial skin resection was performed by sharp dissection. Electrocautery was then used to excise the lobulated fat accumulation. Two layers of 3/0 Vicryl? sutures were used in the lax subcutaneous tissue. 4/0 Vicryl? rapide was used on the skin to approximate wound edges. Suction drains were left in place for 48 h to reduce the dead space and to manage postoperative bleeding. The patient was instructed to keep ice and compression pads on the area for the first 24 h and to keep the area clean. This was followed by the application of antibiotic ointment two times a day on the wounds to avoid blood crust formation and to keep the skin soft. Results: Stitches were removed on POD 14 after an overall uneventful postoperative course. The sensitivity of the labia majora's interior aspect was preserved, even initially. With the legs slightly open, the labia majora just covered the entrance to the vagina. The clitoris and labia minora became visible again, restoring a normal anatomical appearance. Moderate edema was observed for 4 weeks after surgery. Conclusion: The surgical technique used provided an excellent result according to the patient, who regained her self-confidence and started having a normal sexual life again. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
机译：背景：我们提出了一个罕见的案例，涉及严重的大阴唇肥大。这位39岁的已婚妇女在进行长期抗逆转录病毒治疗后，出现了大阴唇的临床上明显的双侧脂肪营养不良。不同的联合用药方案，包括Crixivan ?、 Epivir？和Zerit？等药物。从1998年至2005年对患者进行了药物治疗。患者目前采用Atripla？疾病得到控制，没有其他合并症。即使当被内衣覆盖时，耻骨隆起的严重程度也会产生类似于男性生殖器的外观。这种解剖上的异常明显损害了她的社交生活，并迫使她避免一般穿紧身裤，泳衣和紧身衣。她还避免了任何性行为。方法：将她的阴毛剃光。标记皱痕和外阴粘膜以免被侵犯。标出估计要去除的皮肤和脂肪量。术中用特技钉缝合法标记大阴唇切除的程度。缝合线留在原处，以验证剩余皮肤的准确张力。该过程是在全身麻醉下对患者进行的。通过锋利的解剖进行唇部皮肤切除。然后使用电灼术切除叶状脂肪堆积。两层3/0 Vicryl？缝线用于松弛的皮下组织。 4/0 Vicryl？使用rapide在皮肤上近似伤口边缘。抽吸引流留在原处48小时，以减少死腔并处理术后出血。指示患者在最初的24小时内在该区域保留冰块和压缩垫，并保持该区域清洁。然后每天两次在伤口上涂抗生素软膏，以避免形成血结皮并保持皮肤柔软。结果：术后总体顺利进行，在POD 14上去除了缝线。即使在最初，大阴唇内部的敏感性也得以保留。双腿稍微张开，大阴唇刚好覆盖了阴道的入口。阴蒂和小阴唇再次变得可见，恢复了正常的解剖外观。术后4周观察到中度水肿。结论：根据患者的手术方法，其恢复了自信心并重新开始正常的性生活，为患者提供了出色的效果。证据级别V：该期刊要求作者为每篇文章分配一个证据级别。有关这些循证医学等级的完整说明，请参阅目录或在线作者须知www.springer.com/00266。

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