Development and Validation of a Plastic Surgery-Oriented Anatomical Scoring System for Surgical Indications in Vulvar Lichen Sclerosus

Background: Vulvar lichen sclerosus is a chronic inflammatory condition that often leads to progressive anatomical distortion and functional impairment. For patients with advanced-stage disease, surgical intervention becomes a treatment option. However, a standardized tool to guide surgical decision-making from a plastic surgery perspective is currently lacking. Methods: A retrospective cohort study was conducted on 27 patients with vulvar lichen sclerosus who underwent reconstructive surgery. A novel anatomical scoring system was developed based on 4 domains, including the clitoral hood, vaginal outlet, labia minora, and labia majora. Each domain was scored independently from 0 to 3 according to anatomical changes and corresponding clinical symptoms. Two independent plastic surgeons performed all assessments. Interrater reliability was evaluated using the intraclass correlation coefficient. The concordance between threshold-defined surgical indications and actual surgical procedures was examined to assess clinical validity. Results: The mean age of the cohort was 38.3±10.0 years. The scoring system demonstrated excellent interrater reliability, with an intraclass correlation coefficient of 0.965 for the total score. The optimal cutoff values determined by the minimum misclassification method were 4 for the clitoral hood, 2 for the vaginal outlet, 3 for the labia minora, and 4 for the labia majora. Conclusions: This Plastic Surgery Anatomical Scoring System for Vulvar Lichen Sclerosus provides a valid tool for standardizing surgical indications. By linking each anatomical domain to a specific reconstructive procedure, it can help plastic surgeons decide not only whether to operate but also which procedure to perform.