Challenges and Advances in Vulvovaginal Disorders_OnDemand-3. Instructions for Postoperative Treatment After Lichen Planus Surgery

3. Instructions for Postoperative Treatment After Lichen Planus Surgery

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Postoperative treatment after lichen planus surgery involves careful management to prevent vaginal adhesions and ensure proper healing. Initially, a Foley catheter is placed in the bladder. An EEA (End-to-End Anastomosis) sizer, lubricated and inserted into the rectum, helps guide the correct angle for lysing vaginal adhesions, with incisions made parallel to the sizer. The outer vagina is opened using a 15 blade and Metzenbaum scissors, followed by blunt and sharp dissection to achieve adequate vaginal length and diameter. The EEA sizer is used for blunt dissection as well.<br /><br />A vaginal dilator must be left in place for 48 to 72 hours post-surgery to maintain the vaginal space. If approved by the operating room, a Styrofoam piece carved to the appropriate dimensions can serve as a dilator, covered with two sterile condoms or the thumb of a large sterile glove. To keep the dilator in place, the labia majora are sewn together using a durable Nylon suture for 48 to 72 hours. The patient returns for dilator and stitch removal at that time.<br /><br />After removing the dilator, intravaginal steroids are started at night, applied after dilation. The patient is instructed to continue nightly dilation long-term.<br /><br />The intravaginal steroid regimen uses hydrocortisone 100 mg/g in an emollient cream base. Dosage progressively increases starting at 300 mg per vagina nightly for one week, then 400 mg for a week, 500 mg for a week, and tapering down through 400 mg, 300 mg, and 200 mg weekly intervals. Long-term maintenance involves 100 mg nightly for several months, eventually reducing to 25-50 mg suppositories to avoid reliance on compounding pharmacies.

Keywords

lichen planus surgery

postoperative treatment

vaginal adhesions

Foley catheter

EEA sizer

vaginal dilator

intravaginal steroids

hydrocortisone cream

vaginal dilation protocol

nylon suture labia closure