Lipofilling of Perineal and Vaginal Scars
Notice bibliographique
Résumé
Sir:FigureChronic pain after episiotomy caused by scar contracture or neuroma formation remains a serious problem.1 The therapy of choice can be simple resection of the scar tissue with primary wound closure or local flaps. Recovery after these corrections may take time, with the risk of receiving no improvement, more pain, or poor cosmetic results. We have performed a prospective study with assessment of perineal/vaginal pain and sexual functioning before and after autologous free fat transplantation for correction of scars following childbirth in 20 patients (mean age, 34 ± 7.5 years; mean time after episiotomy, 10.3 ± 2.3 months). Mediolateral episiotomy had been performed in 18 patients. Two patients had pain after perineal laceration. Three patients have had correction of the scars with primary excision and no signs of improvement 6 months ago. All patients reported dyspareunia and other pain-related problems. Lipofilling was performed according to the Coleman technique,2 with scar release and implantation into parallel tunnels on multiple layers under the scars (Fig. 1). A special technique of infiltration with one finger in the vagina and another in the rectum was used to avoid injury of the rectum in case of lipofilling of scars of the posterior wall of the vagina. Perineal pain was assessed preoperatively and at different time points after lipofilling using the short-form McGill Pain Questionnaire, including the Present Pain Intensity index and a visual analogue scale.3 Sexual functioning was assessed with a revised Sabbatsberg Sexual Self-Rating Scale before and after intervention.4 Follow-up of the patients was scheduled after 1, 3, and 6 months. The distribution of variables within the patient group was compared by nonparametric analysis of variance (two-sample Wilcoxon test), and differences between dependent (paired) data were assessed by the nonparametric paired test (signed rank test). A value of p < 0.05 was considered to be statistically significant. An average volume of 12 ± 3 cc of autologous fat was injected (range, 7 to 15 cc). Four patients underwent two lipofilling sessions because of improvement with the first lipofilling but had remaining painful areas in one part of the scar. The average interval between these sessions was 4 ± 1.5 months. All patients made good postoperative recovery without major complications. Eighteen of 20 patients had an immediate subjective improvement of their pain obviously attributable to release of severe scar contractures. One month after lipofilling, the short-form McGill Pain Questionnaire score was significantly reduced in comparison with the score before treatment (p < 0.05) (Fig. 2). Three and 6 months after treatment, the score had decreased further (p < 0.05). The Present Pain Intensity index and visual analogue scale score were also significantly reduced after 1, 3, and 6 months (p < 0.05). The Sabbatsberg Sexual Self-Rating Scale score showed a significant increase after lipofilling (p < 0.05). Fifteen patients were very satisfied with the small operation and five were satisfied.Fig. 1: Release of scar tissue combined with fat injection 8 months after mediolateral episiotomy in a 28-year-old patient with dyspareunia.Fig. 2: Short-form McGill Pain Questionnaire scores before and 1, 3, and 6 months after lipofilling in patients with episiotomy and perineal laceration (*p < 0.05 versus before).A number of studies recently demonstrated the reliability, long-term stability, and safety of autologous free fat transplantation in reconstructive procedures.5 In our opinion, lipofilling also seems to be a promising treatment for correction of perineal/vaginal scars after episiotomy and perineal laceration. It is well tolerated and offers encouraging results, with improvement of pain and better sexual function. Dietmar Ulrich, M.D., Ph.D. Franziska Ulrich, M.D. Department of Plastic and Reconstructive Surgery Lena van Doorn, M.D., Ph.D. Department of Gynecology Steven Hovius, M.D., Ph.D. Department of Plastic and Reconstructive Surgery, Erasmus University Hospital, Rotterdam, The Netherlands DISCLOSURE The authors have no financial interest in this research project or in any of the techniques or equipment used in the study. The authors have no conflicts of interest to disclose.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».