Vulvar lichen sclerosus is a chronic disease with a great impact on quality of life, causing voiding and sexual symptoms. In severe cases, refractory to topical treatments and interval dilatation, a definitive surgical treatment could be offered. Oral mucosa has previously demonstrated good outcomes against lichen sclerosus in male urethral surgery. We propose vulvar reconstruction using oral mucosa grafts as anovel intervention with promising results.

We present by video the usefulness of the oral mucosa graft for the surgical reconstruction of severe vulvar stenosis due to lichen sclerosus. We show the surgical intervention step by step.  Subsequently, we expose our experience in 3 cases of our series with intermediate-term follow-up.

Initially, we perform the opening of fused labia minora, with sharp excision of affected tissue until the preserved vaginal cavity is fully exposed. After measuring the mucosal defects in both labia minora, we perform oral mucosa harvesting from both inner cheeks. Donor sites are closed using interrupted sutures. We demonstrate the graft placement over labia minora de-epithelialized areas using absorbable material, and postoperative dressing for graft care. Finally we expose the clinical cases of 3 patients of our series, showing preoperative appearance, aspect after surgical intervention and one-year postoperative clinical outcomes.

Labia minora grafting using oral mucosa would prevent lichen sclerosus recurrences, maintaining the patency of vulvar introitus. After 1 year follow-up our results are encouraging, with no need for any re-intervention or dilatation.