|
VULVAR FOLD DERMATITIS
Overview
Excessive skin folds around the vulva can lead to the accumulation of urine and vaginal secretions. A moist, dark environment is created where bacteria and yeast can thrive, resulting in vulvar fold dermatitis. Episioplasty, also known as vulvoplasty, is a reconstructive procedure performed to remove excess skin folds around the vulva to provide better ventilation of the area. (See Figures 1-2)
Figure 1. Excessive perivulvar skin covering the vulva.
Figure 2. With the excessive skin retracted, the vulva is visible.
Causes and Risk Factors
This condition occurs in older, obese female dogs or younger dogs that have infolded "juvenile" vulvas (possibly a result of being spayed at a very young age).
Signs and symptoms
Vulvar fold dermatitis may cause licking or scooting. A foul odor may be present. In some dogs, ascending urinary tract infection is a secondary sequela, and therefore frequent or bloody urination may be noted.
Exam and screening tests
Before surgery, your veterinarian will want to do a good physical examination (including a vaginoscopy to check for other abnormalities), blood work, urinalysis, and bacterial culture.
Treatment options
Medical management of vulvar fold dermatitis with systemic antibiotics, topical antibiotics, cleansing, drying agents, or lotions may be successful, but is often unrewarding. For the majority of cases surgery is warranted.
Surgical treatment (episioplasty) is a reconstructive procedure aimed at removing the redundant skin folds around the vulva. The amount of perivulvar skin to be removed is determined by pinching the redundant skin between the thumb and forefingers. A crescent-shape incision is made around the vulva and the excessive skin and subcutaneous tissue is removed. (See figures 3-4)
Figure 3. Two crescent-shaped incisions have been made around vulva and the skin lying between them has been removed.
Figure 4. Skin and subcutaneous sutures have been placed. The episioplasty has been completed.
Aftercare
Aftercare for the patient will consist of controlled activity for 2 weeks. Cold compresses during the first 24-48 hours will aid in decreasing inflammation. Oral analgesics, such as non-steroidal anti-inflammatory drugs or mild opoids may be recommended. Surgical sutures are removed 10-14 days after surgery. Most patients are irritated by the surgical wound, and need to wear an Elizabethan collar until the sutures are removed. Antibiotics may be necessary to control the pyoderma.
Prognosis
The prognosis after episioplasty is excellent. Inadequate removal of perivulvar skin may result in persistence of perivulvar dermatitis, and removal of too much perivulvar skin may cause dehiscence due to tension. These complications are avoided with good surgical technique and operative planning.
—Brenda Jo Salinardi, DVM, MS
Diplomate ACVS
Posted 8/21/2006
| 
