Vaginal reconstruction with an island flap of the inferior epigastric vascular pedicle

Vaginoplasty technique using vulvoperineal flaps

The incidence of vaginal agenesis is 1 in 5,000 live newborn baby girls. The most frequent cause is Mayer-Rokitansky-Küster-Hauser syndrome. This report presents three reconstruction cases managed with vulvoperineal fasciocutaneous flaps in patients experiencing this syndrome. It depicts the stages of the procedure and the anatomic bases for it. This technique allows the creation of a sensitive neovagina with high-quality coverage that provides a physiologic and a natural inclination angle together with a correct anatomic axis to make a sexual relationship possible. The procedure is performed in one surgical stage with minimum morbidity for the patient. Its major inconvenience is hair growth inside the vagina. Nevertheless, this decreases as time passes due to follicle atrophy and cutaneous metaplasia.

LEVEL OF EVIDENCE V

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Vaginal reconstruction with two lower abdominal skin flaps in rabbits: histological and macroscopic evaluation

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.

Vaginal reconstruction with the femoral veno-neuroaccompanying artery fasciocutaneous flap

The arterial anatomy of the anteromedial thigh was investigated in ten fresh cadavers that had been systemically injected with a lead oxide-gelatin mixture. The arteries accompanying the great saphenous vein and the anterior cutaneous branches of the femoral nerve were found to have branches not only to the cutaneous vein and nerve, but also to the skin. On the basis of the anatomy of these accompanying arteries, a pedicled fasciocutaneous flap containing them was developed consisting of an adipofascial pedicle and a skin island. This flap has been named the femoral veno-neuroaccompanying artery fasciocutaneous flap (the femoral V-NAF flap, the great saphenous-femoral V-NAF flap) and has been applied in three cases of vaginal reconstruction.