1
|
|
2
|
Özyazgan İ, Yontar Y, Aygen EM, Aydin A. Use of infragluteal folds as a full-thickness skin graft donor site for construction of the neovagina in cases of Mullerian agenesis. J Obstet Gynaecol Res 2018; 44:1985-1994. [PMID: 30117221 DOI: 10.1111/jog.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/15/2018] [Indexed: 11/27/2022]
Abstract
AIM The aims of this study were to present the results of using infragluteal folds as a skin graft donor site in cases of Mullerian agenesis undergoing full-thickness skin graft vaginoplasty and to evaluate the outcomes of the surgical technique. METHODS Demographics and clinical parameters of 24 consecutive Mullerian agenesis patients refusing any dilatational procedure and undergoing neovaginal construction using infragluteal folds skin grafts from May 2004 to July 2015 were analyzed. RESULTS The mean age of the patients was 21.5 ± 5.7 years. Five patients had nonfunctional rudimentary uterus, one patient had unilateral ovarian agenesis, one patient had unilateral renal agenesis, and one had undergone a previous vaginoplasty. There were no serious complications needing surgical or medical intervention. The depth of the neovagina in patients with a follow-up period of more than 6 months (n = 17) varied from 7 to 12 cm. Of these patients, the sexually active ones (n = 8) did not complain of dyspareunia or vaginal dryness during sexual intercourse. The resulting scars were satisfactory and acceptable for all patients. CONCLUSION It has been our practice to use infragluteal folds as a skin graft donor site for full-thickness skin graft vaginoplasty. We believe that the results of this study demonstrate that this area is versatile and an excellent alternative to the groins and lower abdomen. Further clinical and histomorphological investigations are necessary for strong statements and results.
Collapse
Affiliation(s)
- İrfan Özyazgan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Yalcin Yontar
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ercan M Aygen
- Department of Obstetrics and Gynecology, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Ahmet Aydin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Erciyes University, School of Medicine, Kayseri, Turkey
| |
Collapse
|
3
|
Bhaskar V, Sinha RJ, Mehrotra S, Mehrotra CN, Singh V. Long-term outcomes of sigmoid vaginoplasty in patients with disorder of sexual development - our experience. Urol Ann 2018; 10:185-190. [PMID: 29719332 PMCID: PMC5907329 DOI: 10.4103/ua.ua_88_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction To report our experience with sigmoid vaginoplasty in patients with different forms of disorder of sexual development and their long-term follow-up. Materials and Methods This is a retrospective study of patients who underwent sigmoid vaginoplasty between July 2004 and June 2015 at our center. Follow-up included a physical examination to assess vaginal length and width, cosmetic appearance of the neovagina, and occurrence of any complications. Results The current study included eight patients with mean age 19.5 years. The mean operative time was 164 min. No significant intraoperative or immediate postoperative complications occurred. Follow-up period ranges from 21 months to 12 years with mean of 7.5 years. In all patients, the neovagina was found to have a satisfactory cosmetic appearance. Seven patients are sexually active and satisfied. Conclusion Sigmoid vaginoplasty is safe and acceptable procedure in patients having vaginal agenesis. Sigmoid vaginoplasty has acceptable cosmetic results and complication rate.
Collapse
Affiliation(s)
- Ved Bhaskar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul J Sinha
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Seema Mehrotra
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - C N Mehrotra
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
4
|
Non-grafted Vaginal Depth Augmentation for Transgender Atresia, Our Experience and Survey of Related Procedures. Aesthetic Plast Surg 2015; 39:733-44. [PMID: 26163098 DOI: 10.1007/s00266-015-0523-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Neovaginal atresia especially following male-to-female transgender vaginoplasty is a distressing concern. A pelvic space must be re-created. Traditionally, an epithelial or mucosal lining is employed to cover the space. However, in our series of 18 patients, a non-grafted approach has been equally efficacious, as previously described by others. AIM To follow the outcome of male-to-female transsexuals undergoing secondary depth enhancement without use of graft or flap. METHODS Patient selection included two operated on elsewhere, one of whom had a lower abdominal skin graft, and the remainder done here using an inverted penile skin flap supplemented by a scrotal graft extension as needed. The time lag from primary to revision surgery varied from 5 months to 23 years, average 3.7 years. The fascial plane of Denonvilliers was reopened and packed for 7 days to facilitate maintenance of a pelvic space. Patients are requested to perform serial self-dilations with a stent set indefinitely to maintain patency and procure additional depth. Immuno-histochemistry staining was performed to demonstrate estrogen receptor (ER) presence in male genital skin. Estrogen cream may be utilized to facilitate wound healing. Main outcome measures were post-operative depth results and Female Sexual Function Index (FSFI) scores. Several attempts were made to contact all patients for completion of a FSFI. Ten out of 18 responded. RESULTS Following revision of the pelvic space, static depths increased two-fold on average, from 2.4 in. (6.2 cm) to 5.0 in. (12.7 cm). The FSFI domain scores (of desire, arousal, lubrication, orgasm, satisfaction, and pain) were all mid-range or above. Full scale FSFI scores (compilation score) averaged 23.4 (range limits 2-36). Histologic staining showed the presence of ER in genital skin of all genetic males tested regardless of estrogen usage and perceived gender. CONCLUSIONS Given adequate development of the rectal-vesical space and preservation of that space with self-dilation, epithelialization will ensue providing sexual gratification for patient and partner (as per patient). LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
5
|
Spyropoulou GA, Jeng SF, Demiri E, Dionyssopoulos A, Feng KM. Reconstruction of Perineoscrotal and Vaginal Defects With Pedicled Anterolateral Thigh Flap. Urology 2013; 82:461-5. [DOI: 10.1016/j.urology.2013.04.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/18/2013] [Accepted: 04/25/2013] [Indexed: 11/25/2022]
|
6
|
|
7
|
Abali R, Kuvat SV, Bozkurt S, Kayhan A, Yuksel MA, Caliskan H. Report of surgical correction of a cervicovaginal agenesis case: cervicovaginal reconstruction with pudendal thigh flaps. Arch Med Sci 2013; 9:184-7. [PMID: 23513083 PMCID: PMC3598135 DOI: 10.5114/aoms.2013.33071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 03/19/2011] [Accepted: 04/09/2011] [Indexed: 11/17/2022] Open
Affiliation(s)
- Remzi Abali
- Department of Gynecology and Obstetrics, Faculty of Medicine, Namik Kemal University, Turkey
| | - Samet Vasfi Kuvat
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Istanbul University, Turkey
| | - Serpil Bozkurt
- Department of Gynecology and Obstetrics, Faculty of Medicine, Maltepe University, Turkey
| | - Arda Kayhan
- Department of Radiology, Faculty of Medicine, Namik Kemal University, Turkey
| | - Mehmet Aytac Yuksel
- Department of Gynecology and Obstetrics, Cerrahpasa Medical Faculty, Istanbul University, Turkey
| | - Hatice Caliskan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Namik Kemal University, Turkey
| |
Collapse
|
8
|
Liu XY, Li HT, Li L, Chen L, Wang LJ, Ma K, Zhao BB, Hou XH. Chronic urogenital sinus expansion in reconstruction of high persistent cloaca. Pediatr Surg Int 2012; 28:835-40. [PMID: 22820832 DOI: 10.1007/s00383-012-3114-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Soft tissue expansion is a technique useful in reconstruction when a shortage of tissue exists. This study presents an investigation on using chronic balloon expansion in the urethral and vaginal reconstruction of high persistent cloaca. METHODS The common channel was expanded by a balloon, which was progressively inflated over 3-4 weeks at a pressure of 30-50 mmHg until an adequate amount of tissue was obtained. The expanded channel was longitudinally split into anterior and posterior segments: the former was approximated to form a neourethra in continuity with the reconstructed bladder neck and the latter was tubularized to form a vagina. RESULTS Twenty-one patients underwent primary posterior sagittal urethro-vaginoplasty using the expanded urogenital sinus. Histologic examination demonstrated that the expanded tissue consisted of a dense fibrous wall lined with a stratified squamous non-cornified epithelium, which was characterized by active cell mitosis and angiogenesis. The patients were followed-up for 0.6-9 year (mean 5.69 ± 2.43 years). All reconstructed urethras, vaginas, and vulvas were satisfactory in color, texture match, and sensation. Urinary continence (grades I and II) was observed in all patients without intermittent catheterization. Two complications were encountered in our study. One patient showed a distal urethral dehiscence and a secondary urethroplasty was performed 6 months after the operation. Another patient developed a redundant urethra upon reaching puberty and urethroplasty was needed. CONCLUSION Chronic balloon expansion allows the formation of adequate tissue similar in appearance and type to the vagina and urethra. It also provides a valuable surgical alternative for the management of high persistent cloaca.
Collapse
Affiliation(s)
- Xiang-Yang Liu
- Department of Pediatric Surgery, Cangzhou Central Hospital Affiliated Hebei Medical University, Cangzhou, 061001, China
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Nowier A, Esmat M, Hamza RT. Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development. Int Braz J Urol 2012; 38:380-6; discussions 387-8. [DOI: 10.1590/s1677-55382012000300011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2011] [Indexed: 01/08/2023] Open
|
10
|
de Souza JP, Rosito TE, Delcelo R, Ortiz V, Macedo A. Vaginal reconstruction with two lower abdominal skin flaps in rabbits: histological and macroscopic evaluation. Eur J Obstet Gynecol Reprod Biol 2011; 160:179-84. [PMID: 22112584 DOI: 10.1016/j.ejogrb.2011.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 08/15/2011] [Accepted: 10/19/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the use of two skin flaps of the lower abdominal wall in the creation of a cylindrical conduit in vaginal reconstruction surgery in rabbits, through macroscopic and histological analysis. STUDY DESIGN An experimental study was performed in 16 female New Zealand rabbits, consisting of the use of two rectangular-shaped skin flaps of the lower abdominal wall measuring 1cm longitudinally and 3 cm transversely anastomosed to each other through continuous suture of the edges of the two flaps to create a tube. Hysterectomy and excision of the vaginal vault were performed, and the skin tube was anastomosed to the remaining vaginal stump with separate points of polyglycolic acid 4.0. Animals were divided into 4 groups according to the euthanasia at 2, 4, 8 and 12 weeks, when after excision of the neovagina, macroscopic and histological evaluation with hematoxylin-eosin and Masson trichrome were performed. RESULTS Of 16 operated rabbits, only 1 presented partial abdominal wall dehiscence, not compromising the flap viability. The macroscopic analysis of the vaginal conduit showed that it was kept open throughout the experimental steps, with a good patency and gauge, showing a slight retraction in the skin conduit length of no statistical significance. In the histopathological analysis, a local inflammatory process in the anastomosis was observed, which was larger in the early evaluation but decreased in late evaluations, as well as the local fibrosis process. Integration of the vaginal and skin epithelia was made with no alterations in their primary characteristics. CONCLUSION The use of two skin flaps of the lower abdominal wall as a vaginal conduit presented good integration between skin and vaginal tissue with minimal length retraction, kept the patency during evaluations and did not show strictures, presenting good local healing and a low rate of complications.
Collapse
Affiliation(s)
- Jesus Pires de Souza
- Department of Urology, Federal University of São Paulo, Rua Maestro Cardim, 560/215, 01323-000, São Paulo, SP, Brazil
| | | | | | | | | |
Collapse
|
11
|
Transverse Singapore flap for reconstruction of a congenital rectovaginal fistula in an 18-month-old infant. Ann Plast Surg 2009; 63:650-3. [PMID: 19816154 DOI: 10.1097/sap.0b013e31819ae002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many different types of flaps have been used for reconstruction of rectovaginal fistulae. This is the first report of using a transverse Singapore flap for repairing a large 3 cm by 3-cm complex congenital rectovaginal fistula in an 18-month-old infant with VATER syndrome. A right transverse Singapore flap was used to reconstruct both the posterior wall of the vagina and the anterior wall of the rectum while simultaneously joining the 2 structures to the perineum. Despite minor postoperative delayed healing which resolved, the patient has maintained a functionally and cosmetically satisfactory result at 20-month follow-up. For complex rectovaginal fistulae reconstruction in the pediatric patient, the transverse Singapore flap is a reliable and viable option for the reconstructive surgeon.
Collapse
|
12
|
Colon replacement of vagina to restore menstrual function in 11 adolescent girls with vaginal or cervicovaginal agenesis. Pediatr Surg Int 2009; 25:675-81. [PMID: 19543898 DOI: 10.1007/s00383-009-2391-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
Abstract
AIM Cervicovaginal or vaginal agenesis with functioning endometrial tissue is rare. We report the construction of a colon conduit which is anastomosed to posterior uterine wall or upper vaginal pouch to allow menstruation. MATERIALS AND METHODS We report seven girls with cervicovaginal agenesis and four with lower vaginal agenesis (aged 12-20 years) who presented with painful cryptomenorrheoa. All the girls wanted to conserve their uterus and menstruate normally. A colon conduit was constructed for the egress of menstrual blood. The colon conduit was anastomosed to the posterior uterine wall in the seven girls with cervicovaginal agenesis and to the distended upper vaginal pouch in the four girls with vaginal agenesis. Utero-colonic neovaginal anastomosis was performed only after excising a circular portion of the posterior myometrium to prevent stenosis. RESULTS The colon conduit functioned effectively, providing an egress for regular painless menstruation. One patient had stenosis of the perineal neovaginal orifice for which dilations were done. One girl has married and reports satisfactory intercourse. The mean follow up is 2.2 years. CONCLUSIONS This group of patients forms a separate subgroup needing a conduit not only for sexual function but also for menstruation. However, if treated by the method described herein, they should be cautioned against pregnancy if they have cervicovaginal agenesis and against vaginal delivery if they have vaginal agenesis.
Collapse
|
13
|
Ang Z, Qun Q, Peirong Y, Fei LZ, Lin Z, Wei LW, Lin ZH, Rong FB. Refined DIEP Flap Technique for Vaginal Reconstruction. Urology 2009; 74:197-201. [DOI: 10.1016/j.urology.2008.11.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/27/2008] [Accepted: 11/30/2008] [Indexed: 11/27/2022]
|
14
|
Tham NLY, Pan WR, Rozen WM, Carey MP, Taylor GI, Corlett RJ, Ashton MW. The pudendal thigh flap for vaginal reconstruction: optimising flap survival. J Plast Reconstr Aesthet Surg 2009; 63:826-31. [PMID: 19394909 DOI: 10.1016/j.bjps.2009.02.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 12/10/2008] [Accepted: 02/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The pudendal thigh fasciocutaneous (PTF) flap is a useful flap in perineal reconstruction, that is reliable when small but is traditionally unreliable when large flaps are raised. Large flaps in particular, are associated with an increased incidence of apical necrosis. Thorough descriptions of the vascular anatomy of this flap have been lacking from the literature, with the current study evaluating this anatomy, aiming to provide the anatomical basis for vascular problems and for techniques to maximise its survival. METHODS Five unembalmed human cadaveric pelvis specimens were studied. Lead oxide injectant enabled radiographic and dissection analysis of the arterial anatomy of the integument of the perineum. RESULTS A consistent pattern of vascular supply was found in all specimens. 1: the blood supply to the pelvic floor was supplied sequentially by the posterior labial/scrotal arteries, cutaneous branches from the anterior branch of the obturator artery, and branches from the external pudendal arteries. 2: these vessels ran close to the midline, medial to the PTF flap. 3: the posterior labial/scrotal arteries were deep to the Colles' fascia and the branches from the obturator artery and external pudendal arteries were located superficial to the Colles' fascia. CONCLUSION This study has demonstrated that the PTF flap is a three vascular territory flap and that the pedicle is situated close to the midline. This may explain why regions of the PTF flap may have a potentially precarious blood supply, and suggests that the PTF flap should be designed more medially. Given the third territory of supply to the apex of the flap, a delay procedure may help to avoid flap necrosis.
Collapse
Affiliation(s)
- Nicole L Y Tham
- Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology, University of Melbourne, Grattan Street, Parkville, 3050 Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|
15
|
Karateke A, Gurbuz A, Haliloglu B, Kabaca C, Koksal N. Intestinal vaginoplasty: is it optimal treatment of vaginal agenesis? A pilot study. Int Urogynecol J 2005; 17:40-5. [PMID: 15997363 DOI: 10.1007/s00192-005-1349-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
The outcome of 11 cases with vaginal agenesis who underwent intestinal vaginoplasties are presented. Patients were between 18 and 37 years old. Ileum vaginoplasty and sigmoid colon vaginoplasty were carried out in two and nine cases, respectively. Ileum necrosis at donor site requiring ileum resection and bilateral ileostomy encountered in one of the cases was the major complication. Mild stenosis responsive to finger dilatation had been detected in two women with sigmoid vaginoplasty. Excess mucous production, long operation time, and shortness of mesentery of ileum led us to abandon ileum vaginoplasty, and sigmoid colon vaginoplasty was performed in the following cases with vaginal agenesis. All of the neovaginas were patent and functional. We suggest sigmoid colon vaginoplasty as the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, short recovery time compared with ileum vaginoplasties; and in patients reluctance to prolonged use of dilatators or in those who experienced previous failure of the other treatment modalities.
Collapse
Affiliation(s)
- Ates Karateke
- Department of Gynecology, Zeynep Kamil Women's and Children Diseases Education and Research Hospital, Uskudar, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
16
|
Rajimwale A, Furness PD, Brant WO, Koyle MA. Vaginal construction using sigmoid colon in children and young adults. BJU Int 2004; 94:115-9. [PMID: 15217443 DOI: 10.1111/j.1464-4096.2004.04911.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the age at which patients who required vaginal replacement (an uncommon procedure in children) were diagnosed, and the cause of their anomaly, and to relate these variables to the surgical outcome. PATIENTS AND METHODS Patients who had vaginal replacement at the author's institution between 1990 and 2002 were reviewed retrospectively. Depending on the age at reconstructive surgery, patients were divided into pre- and postpubertal groups. RESULTS A neovagina was constructed in 23 patients during the study period; sigmoid colon was used in 20 but not in two patients with cloacal exstrophy and in one with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS). These cases were excluded from the analysis of outcomes and complications. Group 1 comprised patients diagnosed and treated before puberty and group 2 those diagnosed and/or treated afterward. In group 1 the presenting diagnoses included androgen insensitivity syndrome (AIS) in six patients, MRKHS in two, cloacal exstrophy in two, vaginal tumour in one, Müllerian duct renal aplasia cervicothoracic somite dysplasia, vertebral abnormalities, anal atresia, cardiac anomalies, tracheo-oesophageal fistula, and/or oesophageal atresia, renal abnormalities and limb defects syndromes in one each. In group 2 the presenting diagnoses included MRKHS in seven, AIS in two, and congenital adrenal hyperplasia in one. Complications included superficial wound infection (two patients), recurrent introital stenosis, and blind loop mucocele, complete stenosis of perineal neovaginal opening (one each) and dyspareunia in three. Neither age nor pelvic habitus (android vs gynaecoid) influenced the outcome, and the cosmetic results were excellent in all the patients. CONCLUSION Isolated sigmoid neovaginal construction appears to be applicable to many diagnoses and in patients at any age. Although an android pelvis can present technical challenges, in this experience it was not associated with a greater complication rate. The long-term satisfaction with the sigmoid neovagina for intercourse, especially in those constructed before puberty, still requires long-term evaluation.
Collapse
|
17
|
Miranda ML, Oliveira-Filho AGD, Lemos-Marini SHV, Guerra G, Bustorff-Silva JM. Labioscrotal island flap in feminizing genitoplasty. J Pediatr Surg 2004; 39:1030-3. [PMID: 15213892 DOI: 10.1016/j.jpedsurg.2004.03.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Stenosis of the vaginal introitus is the most frequent complication after genital reconstruction for ambiguous genitalia associated with congenital adrenal hyperplasia (CAH). With the aim of enlarging the vaginal introitus, the authors present a technical modification of the introitoplasty that uses a bilateral cutaneous island flap based on the perineal superficial branches of the internal pudendal artery. METHODS Eleven girls with CAH and Prader III to V genital ambiguity were included. Feminizing genitoplasty was performed in 1 stage. Bilateral cutaneous labioescrotal island flaps, based on the posterior labial artery, were included in the introitoplasty. The cosmetic results of the genitoplasty were evaluated by photographic analysis of the external genitalia. RESULTS Integrity of the vaginal introitus as well as excellent integration of the flap and absence of additional scars in the donor area were assessed in all girls. CONCLUSIONS This modified island flap is technically feasible and reproducible producing no additional sequels in the donor area. It uses perineal skin that is usually excised in other techniques avoiding the use of harvesting skin from adjacent areas. Thus, it can be a useful additional procedure in the introitoplasty in association with the currently used techniques.
Collapse
Affiliation(s)
- Márcio Lopes Miranda
- Division of Pediatric Surgery and Pediatric Endocrinology, State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | | | | | | | | |
Collapse
|
18
|
Abstract
A technique for vaginal reconstruction is described that uses a pedicled jejunal flap. A neovagina was constructed using a segment of jejunum based on the fourth branch of the superior mesenteric artery. This provided an excellent result with adequate length, without the need for a lubricator or stent. Hypersecretion has not been observed.
Collapse
Affiliation(s)
- Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | |
Collapse
|
19
|
Edmonds DK. Congenital malformations of the genital tract and their management. Best Pract Res Clin Obstet Gynaecol 2003; 17:19-40. [PMID: 12758224 DOI: 10.1053/ybeog.2003.0356] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While congenital malformations of the genital tract are not common, the sequelae of their presence can be serious. The practising gynaecologist must be aware of the range of congenital abnormalities that may occur and the symptoms that may result from them. Failure to manage these patients correctly may have long-term sequelae for their psychological, sexual and reproductive health. The involvement of a multi-disciplinary team in dealing with these patients is imperative, and preparation for surgery-particularly in congenital malformations of the vulva and the vagina-is imperative if the long-term sexual function in these patients is to be fulfilled. Surgical correction of vulval abnormalities in adolescence is related solely to sexual function as most of the reconstructive surgery is done in childhood. For the management of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, the recommendation is now that passive dilatation by Franks' technique is the treatment of first choice and only if that fails should surgical approaches be embarked upon. The results of the surgery are similar in all techniques and the particular surgical centre will have its own preference of which technique it adopts. Congenital absence of the cervix is a complex surgical problem and should be dealt with solely in centres with expertise.
Collapse
Affiliation(s)
- D Keith Edmonds
- Women's and Children's Directorate, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London, W12 0HS, UK.
| |
Collapse
|
20
|
|
21
|
|
22
|
Narbona I, Barber M, Eguiluz I, Alonso L, Hijano J, Pérez-Reyes T, Torres E, Aguilera I, Cohen I, Abehsera M. Déficit congénito de 21-α-hidroxilasa. Seudohermafroditismo femenino. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2001. [DOI: 10.1016/s0210-573x(01)77119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
23
|
Abstract
Rhabdomyosarcoma is the most common soft-tissue sarcoma found in children and can arise almost anywhere skeletal muscle is found. It represents 4% to 8% of malignant solid tumors in children, ranking behind central nervous system tumors, lymphoma, neuroblastoma, and Wilms' tumor. Reconstructive surgery has become an integral part of the total plan in patients undergoing radical surgery for rhabdomyosarcoma. Advances in surgical techniques can often provide a reasonable lifestyle for patients.
Collapse
Affiliation(s)
- T W Hensle
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | |
Collapse
|
24
|
Cardon A, Pattyn P, Monstrey S, Hesse U, de Hemptinne B. Use of a unilateral pudendal thigh flap in the treatment of complex rectovaginal fistula. Br J Surg 1999; 86:645-6. [PMID: 10361186 DOI: 10.1046/j.1365-2168.1999.01095.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Cardon
- Department of General Surgery, University Hospital Ghent, Ghent, Belgium
| | | | | | | | | |
Collapse
|
25
|
Abstract
Absence of the vagina presents a challenging problem for the reconstructive urologist. This article reviews the pertinent diagnostic and pretreatment considerations and the surgical options, in particular, bowel vaginoplasty, for these patients.
Collapse
Affiliation(s)
- T W Hensle
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | |
Collapse
|