Horse shoe flap vaginoplasty--a new technique of vaginal reconstruction with labia minora flaps for primary vaginal agenesis.

Reconstruction of the vagina has always been a formidable surgical challenge. A variety of procedures with varying degrees of success have been described, but none has proved to be the ideal method. We have done 15 vaginal reconstructions using labia minora flaps. In the first eight patients, we used two labia minora flaps and sutured them together to create a neovagina. In the last eight patients this new technique of vaginoplasty using horse shoe labia minora flap was used. The neovagina is dilated gradually for a period of 3 months and at the end of 3 months the patient has an adequate sized vagina. All were done for vaginal agenesis. Horse shoe flap vaginoplasty in Mayer, Rokitansky-Kuster-Hauser syndrome is a new technique. The entire hairless skin within the labia majora is used to create a neovagina. Both the labia minora along with the prepucial skin of the clitoris is elevated as a single flap thereby increasing the dimension of the Neovagina and also augmenting the blood supply of the flap, making it more reliable and finally the design simplifies the technique of suturing the neovaginal tube.     

小阴唇中后部去皮法在小阴唇整形术中的应用分析

目的:探讨小阴唇中后部去皮法在小阴唇整形术中的应用价值。方法:选取2010年5月～2012年7月间来我院接受小阴唇整形手术患者77例,所有患者均因为小阴唇肥大而选择手术;按随机数字表将所以患者分为观察组和对照组,观察组采用小阴唇中后部去皮法进行整行,对照组采用弧形双蒂瓣法进行小阴唇整形,观察两组患者外阴形态满意度,感染缺血坏死现象发生率。结果:观察组患者对整形后外形满意度为97.43%,2例出现感染,有2例患者出现缺血现象,经处理患者未出现严重并发症。对照组满意度为78.95%,有1例出现缺血现象,1例患者出现感染,所有患者经处理后好转;两组患者对外形满意度比较具有统计学意义,感染缺血坏死现象发生率比较无统计学意义。结论:小阴唇中后部去皮法应用于小阴唇整形可取的较好的效果,患者对整形后外观满意度高,缝合处较隐蔽,术后瘢痕小,适合临床推广。     

Vaginoplasty and creating labia minora in children with disorders of sex development

International Urology and Nephrology - To report current results of vaginoplasty using the mucosa of the prepuce, and creating labia minora by penile skin in children with disorders of sex...     

Vaginal reconstruction for ambiguous genitalia and congenital absence of the vagina: a 27-year experience

Background/Purpose: Gender assignment to a neonate with ambiguous genitalia is crucial. Patients with an absent vagina require the construction of an artificial vagina. In an effort to improve care, the authors have categorized their experience with this group of children. Methods: Since 1974, we cared for 114 patients with anomalies of the genitalia. There were 53 genotypic girls with congenital adrenal hyperplasia (CAH), 16 genotypic boys with testicular feminization syndrome (TFS), 13 with mixed gonadal dysgenesis (MGD), 9 with Mayer-Rokitansky syndrome, and 4 true hermaphrodites. The remaining 19 had other genital abnormalities. Results: After 1980, patients with CAH underwent clitoral recession and vaginoplasty. All patients with TFS were raised as girls and underwent orchidectomy. Eleven of the MGD patients were given a female sex assignment and underwent gonadectomy. Twenty-eight patients underwent intestinal vaginoplasty including 8 of the TFS patients, 9 with Mayer-Rokitansky syndrome, 8 patients with cloacal anomalies, 2 patients for rhabdomyosarcoma, and 1 of the MGD patients. Conclusions: (1) This review emphasizes the range of diagnoses the surgeon must be prepared to address in patients with ambiguous genitalia. (2) Colovaginoplasty is an excellent procedure for replacement of a completely absent vagina. (3) Continued evaluation of this group will delineate appropriate timing and choice of procedure. J Pediatr Surg 37:955-960.     

L形切除法治疗小阴唇肥大

目的：介绍一种治疗小阴唇肥大的手术方法。方法：在小阴唇中段设计一L形切口线,全层切除设计线之间的小阴唇组织后,两侧创缘对位缝合。结果：本组患者32例,术后切口均Ⅰ期愈合,无并发症发生。所有患者切口无瘢痕挛缩,小阴唇形态明显改善,外观自然,边缘颜色未发生改变,效果满意。结论：本法可较好的保持小阴唇的正常形态和功能,设计操作简单,适合临床广泛开展。     

星形切除法治疗小阴唇肥大

目的 探讨治疗小阴唇肥大的新技术,评价其优缺点.方法 在肥大小阴唇最宽大部位水平方向作一扇形切口线,于垂直方向作一新月形切口线,两者交错形成一形似星形的切口线,全层切除切口内小阴唇组织后,分层缝合切口.结果 22例小阴唇肥大患者,经采用星形切除法修整后,小阴唇均未出现血运障碍,无切口感染,仅1例患者术后24h出现局部血肿,经清除血肿并彻底止血后痊愈.术后随访6～12个月,无小阴唇明显变形及阴道口狭窄,小阴唇外观满意.结论 星形切除法治疗小阴唇肥大,具有设计合理、安全可靠、术后外观良好的优点,可供临床借鉴使用.     

Scrotal reconstruction using thigh pedicle flaps

A technique is described for reconstructing the scrotum in patients who have sustained massive loss of the skin overlying the scrotum and perineum. Scrotal reconstruction with superior and laterally based thigh flaps was done in 3 patients and all 3 had an acceptable cosmetic result. The procedure has the advantage of simplicity, early closure of the wound, excellent cosmetic appearance and maintenance of testicular function.     

游离皮瓣一期阴道再造术

目的　探索游离皮瓣一期阴道再造术的可行性。方法　自 1992年以来 ,设计应用足背游离皮瓣与小腿后侧游离皮瓣行一期阴道再造术 2 5例。结果　手术均获成功 ,随访 6个月～ 6年 ,再造之阴道宽度、深度、柔软度及弹性均符合解剖结构及生理要求。结论　游离皮瓣一期阴道再造术切实可行 ,术后外阴部无手术痕迹 ,易为患者接受     

星形切除法治疗小阴唇肥大

目的探讨治疗小阴唇肥大的新技术，评价其优缺点。方法在肥大小阴唇最宽大部位水平方向作一扇形切口线，于垂直方向作一新月形切口线，两者交错形成一形似星形的切口线，全层切除切口内小阴唇组织后，分层缝合切口。结果22例小阴唇肥大患者，经采用星形切除法修整后，小阴唇均未出现血运障碍，无切口感染，仅1例患者术后24h出现局部血肿，经清除血肿并彻底止血后痊愈。术后随访6～12个月，无小阴唇明显变形及阴道口狭窄，小阴唇外观满意。结论星形切除法治疗小阴唇肥大，具有设计合理、安全可靠、术后外观良好的优点，可供临床借鉴使用。     

Hypertrophy of labia minora in myelodysplastic women. Labioplasty to ease clean intermittent catheterization

Female myelodysplastic patients are sometimes annoyed by hypertrophy of the labia minora, possibly caused by long-term diaper dermatitis. This condition makes intermittent catheterization difficult and impairs the cleanliness and aesthetic appearance of the external genitalia. We successfully performed labioplasty on 3 myelodysplastic females.     

Refinements in vaginal reconstruction using rectus abdominis flaps

An improved method for vaginal reconstruction after pelvic exenteration or abdominal perineal resection is provided by the distally based rectus abdominis flap. This extended flap carries a skin paddle from the upper abdomen on the rectus abdominis muscle and deep inferior epigastric vascular pedicle. The skin paddle is inversely tubed to form a vaginal pouch and delivered transpelvically to the perineum. In addition to providing a vaginal reconstruction for sexual function, this reconstruction lessens pelvic wound complications in the exenteration patient by filling endopelvic dead space and revascularizing these frequently irradiated wounds. This method provides a neovagina with a single flap and does not involve additional donor sites in the thighs. Transpelvic passage from above not only fills endopelvic dead space better than thigh flaps, but also it allows retention of a vaginal cuff in supralevator resections. Another significant advantage of this reconstruction is its great reliability with minimal incidence of paddle loss. This flap design illustrates a type of flap refinement in which specific flaps can carry tissue from adjacent vascular territories because of anastomotic vessels between the two vascular territories, such as the vascular watershed between the deep inferior epigastric and superior epigastric vessels in this case.     

Post-traumatic big toe reconstruction using free flaps

The big toe is of great importance for good stability and gait, but few reports have documented reconstruction of big toe defects. In this study, seven male patients, aged 17 to 59 years at surgery (average: 35 years), were treated for big toe defects. The metatarsophalangeal (MTP) joints of the big toe were intact in all patients. Five patients were treated with free peroneal flaps (including one perforator flap), and two with free scapular flaps; flap sizes ranged from 9 x 4 to 24 x 6 cm. Follow-up periods ranged from 10 to 29 months, (average: 16.6 months). The iliac was used as the grafted bone in four patients and the scapula in one. Six flaps survived completely, and bone unions were achieved within 3 months. One flap became partially necrotic due to arterial thrombosis. All patients returned to their original jobs, and the cosmetic appearances of all toes were acceptable.     

Congenital breast deformity reconstruction using perforator flaps

BACKGROUND: Congenital breast deformities such as Poland syndrome, unilateral congenital hypoplasia, tuberous breast anomaly, and amastia pose a challenging plastic surgical dilemma. The majority of patients are young, healthy individuals who seek esthetic restoration of their breast deformities. Currently, both implant and autologous reconstructive techniques are used. This study focuses on our experience with congenital breast deformity patients who underwent reconstruction using a perforator flap. METHODS: From 1994 to 2005, a retrospective chart review was performed on women who underwent breast reconstruction using perforator flaps to correct congenital breast deformities and asymmetry. Patient age, breast deformity type, perforator flap type, flap volume, recipient vessels, postoperative complications, revisions, and esthetic results were determined. RESULTS: Over an 11-year period, 12 perforator flaps were performed. All cases were for unilateral breast deformities. The patients ranged from 16 to 43 years of age. Six patients had undergone previous correctional surgeries. Eight (n = 8) flaps were used for correction of Poland syndrome and its associated chest wall deformities. Four (n = 4) flaps were used for correction of unilateral breast hypoplasia. In all cases, the internal mammary vessels were the recipient vessels of choice. No flaps were lost. No vein grafts were used. All patients were discharged on the fourth postoperative day. Complications encountered included seroma, hematoma, and nipple malposition. Revisional surgery was performed in 30% of the cases. Esthetic results varied from poor to excellent. CONCLUSIONS: Perforator flaps are an acceptable choice for patients with congenital breast deformities seeking autologous breast reconstruction. Deep inferior epigastric artery (DIEP) or superficial inferior epigastric artery (SIEA) flaps are performed when adequate abdominal tissue is available; however, many young patients have inadequate abdominal tissue, thus a GAP flap can be used. Perforator flaps are a safe, reliable surgical technique. In the properly selected patient, donor-site morbidity and functional compromise are minimized, improved self-esteem is noted, postoperative pain is decreased, and excellent long-term esthetic results can be achieved.     

Treatment of urethral stricture in a female-to-male transsexual with a tubulized flap from the labia minora

Urethral strictures are not uncommon after microvascular phalloplasty in female-to-male transsexuals, and usually are secondary to technical errors or vascular complications. A case of a female-to-male transsexual with recalcitrant urethral stricture after microvascular phalloplasty is reported. After one unsuccessful attempt at direct repair and a failed grafting procedure, a tubulized island flap from the remnants of the labia minora was successfully used to reconstruct the urethral stenosis. Current options for treatment of urethral stenoses in female-to-male transsexuals are discussed.     

Lower limb reconstruction in children using expanded free flaps

Controlled expansion is a technique that increases the area of local tissue available for reconstruction. An extension of this is to expand free flaps prior to elevation, thereby increasing their area. This has been particularly useful in children where there may be insufficient tissue available at free flap donor sites. Four children have had extensive cutaneous defects of the lower limb reconstructed with expanded parascapular free flaps. Measurements indicate an approximate doubling in skin area. There has been normal growth of the affected limbs and there has been no donor site morbidity. Apart from small areas of narrow marginal necrosis at the tip of the flaps in the first three cases, which were of no consequence, healing at the recipient site was complete.