Birth injuries

Femifill® Vulvar for Birth Injuries

Indication

Outcome of natural childbirth

Technique

Harvesting of adipose tissue, appropriate treatment of the same, multilayer implantation of different adipose tissue preparations + CO2 vulvar laser

Procedure

60/90 min, local anesthesia + sedation, day hospital

Postoperative Pain

Poor if common pain relievers are used

Complications

Rare (infections, hematomas)

 Recovery

 2/4 weeks

Surgical revision for birth injuries

Indication

Outcome of natural childbirth

Technique

Revision of scars and underlying layers + harvesting of adipose tissue, appropriate treatment of the same, multilayer implantation of different adipose tissue preparations + CO2 vulvar laser

Procedure

60/120 min, local anesthesia + sedation, day hospital or hospitalization

Postoperative Pain

Poor if common pain relievers are used

Complications

Rare (infections, hematomas)

Recovery

 2/4 weeks

Endovaginal CO2 Laser

Indication

Incontinence/Dryness/Laxity

Technique

Endovaginal CO2 Laser

Procedure

20 minutes

Postoperative Pain

no

Complications

extremely rare

Recovery

immediate

Endovaginal Radiofrequency (RF)

Technique

Endovaginal Quadripolar Radiofrequency (RF)

Indication

Incontinence/Dryness/Laxity

Procedure

20 minutes

Postoperative Pain

no

Complications

extremely rare

Recovery

immediate

Sollevamento del pube

Indicazione

pube molle

Tecnica chirurgica

puboplastica +/- addominoplastica Laser assistita

Procedura

60/180 min , sedazione o anestesia generale, day hospital o ricovero

Complicanze

rare (infezioni, ritardi di guarigione)

Dolore post operatorio

scarso se si utilizzano farmaci antidolorifici comuni

Recupero

4 settimane

Natural childbirth and its consequences

Vaginal childbirth is an ancestrally natural event. It is evident that this is a profoundly traumatic event. Like all traumas, these are better tolerated at a young age when tissues are more elastic. As the age of women giving birth increases, there has been a progressive increase in birth injuries. These consist of the stretching of pelvic muscle bands, skin, and mucous membranes. When tissues lack normal elasticity, once stretched, they will not return to their original position. Practically, this results in vaginal laxity, reduced contractile capacity, and reduced containment capacity with varying degrees of incontinence. There may also be an impact on the ability to retain urine (urinary incontinence).

remedies

Pelvic rehabilitation

Pelvic floor rehabilitation is a crucial step and should be initiated as early as possible. Its importance is equivalent to the rehabilitation of a limb after an accident or surgery. The longer the time passes, the lower the recovery capacity. Rehabilitation should be guided by obstetric personnel properly trained and passionate about their work.

The goal of rehabilitation is to enhance the contractile capacity of the injured muscle groups and simultaneously increase the woman’s ability to control it. Additionally, there are devices (electrostimulators) that can aid in home-based rehabilitation. Internal rehabilitation should be complemented by the rehabilitation of the posterior and anterior trunk muscles, as well as the upper and lower limbs. It is profoundly incorrect to consider the rehabilitation of a single body segment because it will inevitably lead to alterations in adjacent anatomical parts.

Technology: Laser, Radiofrequency, Focused Ultrasound

In recent years, there has been a real boom in technology applied to the female genital area. Various types of lasers have been proposed as optimal treatments for birth injuries. However, their role should be downsized. CO2 and erbium lasers can positively impact vaginal mucosa and skin, but their effect on deeper structures is limited. On the other hand, radiofrequency leaves the skin intact and acts on the tissues immediately beneath it. Unfortunately, its action can only stimulate superficial tissues and cannot reach the deeper fascial structures, which are the real target of rehabilitation. Even focused ultrasound, despite being a method of great interest, has not yet led to significant and evident results. In summary, even the most advanced technologies, while proving useful in stimulating tissues, seem more beneficial in treating atrophy than addressing laxity issues.

Vulvovaginal Lipofilling

The implantation of adipose tissue can be useful postpartum as it is capable of reducing the laxity of the vulvar opening by bringing its walls closer together, simultaneously inducing regenerative processes due to the totipotent cells contained within it.

Vulvoperineoplasty

In cases where pelvic floor rehabilitation has not proven to be sufficiently effective and there is significant laxity of the vulvar opening, vulvoperineoplasty may be considered. This involves the removal of a portion of perineal and vulvar skin, and sometimes vaginal mucosa, along with the suturing of the ligaments rendered lax by childbirth trauma, and sometimes the synthesis of extremely separated muscles. To reduce the sometimes painful impact of perineoplasty, it is useful to employ an innovative technique we have developed, which combines traditional perineoplasty with adipose tissue implantation. The adipose tissue implantation allows bringing the vulvar walls closer together without solely relying on high tension from sutures. This significantly reduces the serious problem of postoperative pain often caused by such tensions.

Il trattamento

Il trattamento delle pazienti infibulate deve mirare a ripristinare funzione ed estetica. La parte funzionale è preponderante e si prefigge lo scopo di rendere la penetrazione non più dolorosa e soddisfacente, permettere un parto per via naturale e recuperare almeno parzialmente la sensibilità clitoridea. Le procedure più comunemente adottate ricorrono all’utilizzo di lembi, innesti, impianti di tessuto adiposo (lipofilling) al fine di apportare tessuto nuovo e sano. L’impianto di cellule di derivazione dal tessuto adiposo permette di ammorbidire le pareti vulvari dure e anaelastiche. Si sono messe a punto tecniche che permettono il recupero del moncone clitorideo ovvero la ricerca di porzioni di clitoride non escisso che, identificate e opportunamente dissecate, possono essere portate più in superficie. La superficializzazione del clitoride rimasto permette spesso di riacquistare un po’ della sensibilità negata. L’estetica della vulva riveste pure importanza. La ricostruzione del clitoride, delle piccole labbra con tecniche straordinariamente innovative permette alla donna infibulata di riconquistare un’estetica pressoché normale.
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