岛状阴股沟皮瓣阴道形成术的临床应用

目的 介绍岛状阴股沟皮瓣的解剖学基础及临床应用。方法 以阴唇后血管神经束为蒂在邻近大阴唇之阴肥沟区设计岛状阴股沟皮瓣。结果 自1993～2001年共用以行阴道形成术47例，获得满意效果。结论 岛状阴股沟皮瓣血运丰富，易成活，转移时带有部分感觉神经，并发症少，是形成阴道的理想术式。     

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.     

Combined cervical and vaginal reconstruction with prefabricated pudendal thigh flap in a case with cervical and vaginal agenesis (MURCS syndrome): a new and original technique

In the presence of functional endometrium, in addition to the construction of anatomically, functionally normal and sensitive neovagina and cervix, the preservation of the uterus for future possible pregnancies must also be considered as the main goal in this process. So far, hysterectomy was the general treatment modality in such cases. For maintaining cervical patency, there were no reports in the literature related to cervical prefabrication using flaps. In this report we present a case with cervical and vaginal agenesis (MURCS syndrome). In this case combined cervical and vaginal reconstructions were successfully performed by using bilateral pudendal thigh flaps; a real-like cervix and cervical canal had been previously prefabricated on the distal part of one of the pudendal thigh flaps. Sensitivity and function were both preserved and maintained at the end of this operation.     

Secondary reconstruction of vaginal stenosis with bilateral pudendal thigh flaps

Abstract

We report the cases of two patients who had pronounced stenosis of the lower part of the vagina after vaginal reconstruction for congenital vaginal aplasia and hypoplasia. Bilateral pudendal thigh flaps were used for secondary reconstruction, and gave satisfactory results with no signs of recurrence or severe scarring at the donor site.     

Experience with vaginoplasty.

We did 27 vaginoplasties (7 gracilis musculocutaneous flaps, 8 pudendal thigh flaps, 12 full-thickness skin grafts) during the period 1994-2000. The preoperative assessment and postoperative follow up were done in collaboration with the gynaecologists. All patients had vaginal agenesis. With the gracilis flaps we found it difficult to achieve an adequate blood supply. With pudendal thigh flaps we achieved perfect innervation and a good contour, but they did tend to be hairy. With full-thickness skin grafts the innervation was not perfect, but the contour was good. Having compared the three operations during a follow up period ranging from 1-5 years we think that the full-thickness skin graft gives the best results.     

应用腹壁下动脉穿支皮瓣再造阴道

目的探讨应用腹壁下动脉穿支皮瓣再造阴道的优缺点。方法2004年1月~2005年5月,采用腹壁下动脉穿支(deepinferiorepigastricperforator,DIEP)皮瓣再造阴道5例,年龄19~40岁。先天性无阴道4例,阴道肿瘤1例。术前常规用超声多普勒检测DIEP,设计10cm×9cm~12cm×11cm的菱形皮瓣,将穿支点包括在皮瓣内。皮瓣切取后作内翻缝合成皮筒状,于腹股沟韧带与耻骨之间沿耻骨结节及耻骨上支内侧面,形成皮筒通过的隧道。将阴道皮筒经隧道移位至人工阴道腔隙或阴道肿瘤切除后的创面中再造阴道。结果5例阴道再造均获得成功,1例患者术后2周出现阴道后壁血肿,经清除血肿后愈合。腹壁供区无任何并发症发生。术后随访1~6个月,再造阴道质地柔软,宽敞,3例有性生活,患者感觉满意。结论应用DIEP皮瓣再造阴道是一种较理想的术式,对广泛的阴道肿瘤切除,由于需填充较多组织,仍是较好选择。     

Laurence-Moon-Biedl Syndrome with Vaginal Atresia

A 15-year-old girl presented with the rare Laurence-Moon-Biedl syndrome, accompanied by vaginal atresia, and cervical dysgenesis. She was treated by hysterectomy and construction of a neovagina with bilateral pudendal thigh flaps. Two brothers and a sister (one of twins) were unaffected but the remaining brother also had the disease.     

Vaginoplasty using deepithelialized vulvar transposition flaps: the Grünberger method

BACKGROUND: One of the most important criteria indicative of the longterm success of vaginal enlargement is the absence of postoperative contracture. Numerous procedures have been developed for reconstruction of an inadequate vagina. Some are technically complex techniques (myo- and fasciocutaneous flaps) with few postoperative complications of vaginal contracture, and others implement autografts with a greater tendency of tissue contraction. STUDY DESIGN: We report here a method of vaginoplasty using deepithelialized vulvar transposition flaps to enlarge the width of narrow vaginas found mainly in cases of congenital adrenogenital syndrome-associated vaginal atresia, but also in cases of acquired vaginal atresia (surgery and radiotherapy-induced). We used deepithelialized dermis from the labia majora to construct an enlarged vaginal entrance and cavity, a technique that is easy to learn and perform. RESULTS: The healing phase of this operation is free of tissue rejection, most likely because of the close embryologic relationship of the cornified, paravaginal squamous epithelium of the labia majora and the noncornified squamous epithelial lining of the lower third of the vagina. The epithelium of the graft loses its cornified layer and becomes nonhair-bearing; its cytology and histology mimic normal vaginal epithelium. Postoperative function and sexual contentment were reported to be satisfying.CONCLUSIONS: The followups of 17 patients who underwent this operation in the last 16 years show optimal cosmetic and functional results.     

会阴部皮肤缺损的修复

采用胸脐皮瓣，腹股沟皮瓣，大腿外侧皮瓣，大阴唇皮瓣修复会阴部皮肤缺损２２例。皮瓣的选择主要根据缺损组织的范围和功能。胸脐皮瓣的优点是不受受区条件的限制，可提供的皮瓣面积大。腹股沟皮瓣优点是操作简便。大腿外侧皮瓣游离移植可降低会阴部的创伤。大阴唇皮瓣主要用于阴道再造。     

球海绵体肌瓣重叠法阴道缩窄术治疗产后阴道松弛

目的：探讨一种有效的阴道缩窄整形术的方法。方法：经阴道口皮肤黏膜交界处切开．剥离阴道黏膜，分离出撕裂的球海绵体肌．形成肌瓣。将肌瓣折叠缝合，然后纵行缝合阴道黏膜，并形成阴道黏膜隆突。结果：本组11例患者均采用球海绵体肌重叠缝合法行阴道缩窄术，9例患者术后随访3个月至2年，夫妻性生活的质量均有明显提高，效果满意。结论：经此手术后可以矫正阴道松弛，提高患者性生活质量，效果确切。     

单侧阴股沟组织瓣修复低位直肠阴道瘘八例及文献复习

目的 探讨阴股沟组织瓣修复低位直肠阴道瘘的临床效果.方法 自2018年1月至2019年12月中国医学科学院北京协和医学院整形外科医院妇科整形中心对8例直肠阴道瘘患者行单侧阴股沟组织瓣修复术.选择阴唇后动脉与阴道后壁水平线的交点为组织瓣旋转轴点,根据瘘口到轴点的距离,沿阴唇后动脉的轴线方向设计组织瓣,根据瘘口大小采取阴股...     

Treatment of vaginal agenesis with modified Abbé-Mclndoe technique

In a patient with vaginal agenesis reconstruction of the neovagina is very important both functionally and psychologically. The absent vagina can be constructed either by surgery or by an intermittent pressure technique defined by Frank. In this paper simple modification is presented which has good anatomical and functional results. For a young woman without a vagina the ideal operation should create a vagina in one stage and at the same time produce a cosmetically attractive scar. This goal can be achieved by the Abbé-McIndoe technique. A modification using a meshed split thickness skin graft for lining the neovagina is presented. Between 1985–1991 in our clinic, 46 patients were treated. A follow-up study has been performed and biopsies were taken from this neovagina; these showed normal vaginal mucosa.     

Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review

BACKGROUND:

Congenital vaginal agenesis is a rare malformation with an incidence of one in 4000 to 5000 female newborns. The purpose of vaginal agenesis treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse.

OBJECTIVE:

To present the results of a modified McIndoe technique with respect to sexual function, vaginal length and complication rates in patients with vaginal agenesis.

METHODS:

Between 2002 and 2010, 23 patients with vaginal agenesis were admitted to the Gynecology Clinic of Istanbul University School of Medicine (Istanbul, Turkey) for vaginal reconstruction. All patients underwent a modified McIndoe procedure. The long-term results with a follow-up period ranging from 18 to 118 months are presented.

RESULTS:

The postoperative mean vaginal length was 8.4 cm (range 6 cm to 11 cm) in 19 patients who used the mould regularly. Among 14 patients who used the mould regularly and had partners, only one experienced severe pain during intercourse and 13 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Conversely, two of three patients who used the mould irregularly experienced severe pain during intercourse and had a mean vaginal length of 6 cm (range 4 cm to 8 cm).

CONCLUSION:

The findings suggest that a modified McIndoe technique is a simple, effective procedure for the treatment of vaginal agenesis; however, proper mould use after surgery remains the cornerstone of the treatment.     

Algorithmic approach to lower abdominal,perineal, and groin reconstruction using anterolateral thigh flaps

Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT‐FC), myocutaneous (ALT‐MC), or vastus lateralis myocutaneous (VL‐MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity. Lower abdomen, groin, perineum, vulva, vagina, scrotum, and bladder wounds reconstructed in 22 patients using ALT flaps between 2000 and 2013 were retrospectively studied. Five ALT‐FC, eight ALT‐MC, and nine VL‐MC flaps were performed. All flaps survived. Venous congestion occurred in three VL‐MC flaps from mechanical cause. Wound infection occurred in six cases. Urinary leak occurred in three cases of bladder reconstruction. One patient died from congestive heart failure. The ALT flap is time tested and dependably addresses most LAPG defects; flap variations are suited for niche defects. We propose a novel algorithm to guide reconstructive decision‐making. © 2014 Wiley Periodicals, Inc. Microsurgery 36:104–114, 2016.     

足部大面积皮肤软组织缺损的皮瓣修复临床分析

目的:比较足部大面积皮肤软组织缺损应用不同类型皮瓣(小腿主干血管逆行皮瓣、皮神经营养血管逆行皮瓣和游离皮瓣)修复的临床效果。方法:57例足部大面积皮肤软组织缺损的患者清创后,应用不同类型的皮瓣进行修复,并比较其成活面积、观察其疗效。其中,小腿主干血管逆行皮瓣14例,面积:7～9cm×11～20cm,平均:8cm×16cm,采用胫后动脉逆行皮瓣3例,腓动脉逆行皮瓣11例;皮神经营养血管逆行皮瓣26例,面积:7～9cm×9～15cm,平均:8cm×11cm,采用腓肠神经营养血管逆行岛状皮瓣23例,隐神经营养血管逆行岛状皮瓣3例;游离皮瓣17例,面积:9.5～15cm×12～28cm,平均:12cm×25cm,采用股前外侧皮瓣13例,隐动脉皮瓣3例,胸背动脉皮瓣1例。结果:57例皮瓣中,完全坏死2例,部分坏死7例,其余全部成活。坏死者全部涉及前足皮肤缺损,其中,主干血管逆行皮瓣完全坏死1例,部分坏死2例;皮神经营养血管逆行皮瓣远端部分坏死5例;游离皮瓣完全坏死1例。统计学分析:皮瓣面积按类型比较(ANOVA),P=0.000,差异有非常显著性意义;皮瓣成活率按类型比较(Kruskal-Wallis Test),P=0.455,差异无显著性意义。经3～18个月随访,所有成活皮瓣血运、外形、质地、功能均满意。结论:大部分足部大面积皮肤软组织缺损可选用皮神经营养血管逆行皮瓣进行修复,但如果涉及前足,特别是缺损较大时,选择游离皮瓣更为适宜。     

提肛肌肌瓣对合重叠缝合法治疗产后阴道松弛

目的 探讨一种有效治疗产后阴道松弛的手术方法。方法 经阴道口皮肤黏膜交界处切开，剥离阴道黏膜，分离出撕裂的提肛肌，形成两个肌瓣。将两肌瓣对合重叠拉紧缝合后缝合阴道黏膜，并形成阴道黏膜隆突。结果 1998年6月至2002年6月将此法用于2l例产后阴道松弛的患者，术后随访16例，随访3个月至2年，患者均感手术后提高了性生活质量。结论 此方法可以提高患者性生活质量，效果确切。     

含部分肌肉的纵行腹直肌肌皮瓣阴道形成术

目的探讨应用含部分肌肉的纵行腹直肌肌皮瓣阴道形成术的效果及优缺点。方法应用含部分肌肉的纵行腹直肌肌皮瓣形成阴道9例,年龄20～35岁,均为先天性无阴道。术前常规用超声多普勒血流探测仪探测腹壁下动脉血管走行,设计纵行6cm×20cm的类梭形皮瓣,将穿支点包括在皮瓣内。于腹股沟韧带与耻骨下方沿耻骨结节及耻骨上支内侧面形成腹膜外隧道,将皮瓣经隧道转移至剥离的人工阴道腔隙中,对折缝合成皮面朝内的皮筒状,形成阴道。结果9例形成阴道的肌皮瓣均成活,腹壁供区无并发症发生。术后随访2～12个月,形成阴道质地柔软、宽敞,6例均暂未有性生活,但患者感觉满意,3例已结婚,诉性生活满意。结论应用含部分肌肉的纵行腹直肌肌皮瓣形成阴道是一种较理想的术式。     

机器人带血管蒂回肠段移植阴道成形术：病例报告并文献复习

目的：初步探讨应用机器人带血管蒂回肠段移植阴道成形术的临床疗效。方法回顾性分析1例应用机器人带血管蒂回肠段移植阴道成形术病例,并复习相关文献进行讨论。结果机器人带血管蒂回肠段移植阴道成形术失血量较少,再造的阴道可达到足够的深度和宽敞度,阴道壁柔软、滑润、有弹性,合乎生理需求,有感觉且稳定不挛缩,手术创伤小,可作为治疗先天无阴道的一种手术方式。结论机器人带血管蒂回肠段移植阴道成形术治疗先天阴道发育不全,观察手术疗效满意,有一定的优势,具有临床应用前景。     

髂腹股沟皮瓣联合股部皮瓣带蒂瓦合移植在手部大面积套脱伤治疗中的应用

目的 介绍髂腹股沟皮瓣联合股部皮瓣带蒂移植治疗手部大面积套脱伤的手术方法和临床效果.方法 对7例手、腕及前臂部广泛皮肤套脱伤的患者,采用髂腹股沟皮瓣联合股前外侧皮瓣带蒂移植修复4例,联合阔筋膜张肌皮瓣带蒂移植2例,联合股前侧皮瓣带蒂移植1例.髂腹股沟部供区创面直接闭合,股部供区创面取全厚层皮片植皮覆盖.术后半个月拆线,并进行皮瓣夹蒂训练,术后1个月根据皮瓣夹蒂训练情况酌情断蒂.急诊一期修复2例,二期修复5例.结果 术后7例皮瓣全部存活,供区伤口I期愈合,随访2～6个月,皮瓣柔软,质地良好,皮瓣外形较臃肿,无坏死及破溃.结论 髂腹股沟皮瓣联合股部皮瓣带蒂移植,二者瓦合可覆盖全手及前臂大面积皮肤套脱伤,手术操作简单,安全性高,易于推广;该皮瓣缺点是需二期手术断蒂,且移植皮瓣外形臃肿,需后期整形.     

皮瓣法阴道再造术41例分析

目的总结先天性无阴道或阴道肿瘤切除术后阴道重建的方法及疗效。方法对先天性无阴道的29例、两性畸形的4例、阴道肿瘤的8例患者采用皮瓣法行阴道重建,包括下腹壁皮瓣22例、腹壁下动脉穿支皮瓣5例、腹直肌肌皮瓣8例、阴囊皮瓣1例、阴股沟皮瓣5例。结果术后下腹皮瓣部分坏死1例,其余皮瓣全部成活。随访3~23个月,1例下腹壁皮瓣者发生阴道口狭窄,1例阴股沟皮瓣者阴道变浅,余再造阴道满意。结论各种皮瓣方法再造阴道有其优缺点,需要根据患者的情况加以选择。