Effective use of a combination of surgical ablative and fractional carbon dioxide laser to treat iatrogenic vulval lymphangiectasia—a case study

Excerpt

We present the case of a 56-year-old female who was diagnosed with dermatofibrosarcoma protuberrans (DFSP) of the pubic area in 1987. She went through several excision surgeries and recurrences culminating in a radical wide excision and flap repair in 2005. She has shown no evidence of recurrence to date. Since the final surgery she suffered with persistent symptoms of swelling and discomfort of the vulva, leaking fluid, and blood into her underwear. On examination, she had oedema and small vesicles affecting her right labia majora (Fig. 1a). Skin biopsy ruled out recurrence of DFSP and revealed lymphangiectasis and lymphoedema, confirming a diagnosis of iatrogenic lymphangiectasia. She was previously told nothing could be done for this. Lymphangiectasia is an abnormal dilation of lymphatic vessels and can be due to congenital malformation or acquired following tissue injury by trauma or surgery. They are difficult to treat and can often be uncomfortable, leading to leakage of fluid and secondary infection. It has been suggested that carbon dioxide laser therapy may work by not only vapourising the lymphangiectases but perhaps sealing off deeper lymphatic vessels [1].

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