马蹄形小阴唇皮瓣阴道再造术

目的 介绍一种改良小阴唇皮瓣行阴道形成术的方法.方法 于尿道膀胱与直肠间造穴,再造阴道之皮瓣为小阴唇及小阴唇与大阴唇之间的无毛区,并在阴蒂上方联合,形成"马蹄"形小阴唇皮瓣,皮瓣下方延长以"V"型汇合于阴道造口处.掀起小阴唇皮瓣,蒂在阴唇后联合处,缝合小阴唇皮瓣形成皮管,翻转小阴唇皮管,以小阴唇皮瓣衬覆阴道腔壁,完成阴道成形术;术后佩带模具3～6个月.结果 本组5例患者,术后随访3～12个月,外阴形态正常,再造阴道外口大于3.0 cm,可容2横指,深度≥18.0cm,具有感觉和分泌功能,接近生理需要.1例在术后3周即有满意的性生活.结论 应用"马蹄"形相连的小阴唇皮瓣,确保了皮瓣的血供,增加了再造阴道的长度,损伤小,并发症少,再造阴道接近正常的解剖及生理状态.     

两种阴道再造术的疗效分析

目的:比较单纯游离皮片法和小阴唇皮瓣联合游离皮片法阴道再造术的手术效果。方法:16例先天性无阴道的患者7例行中厚皮片阴道再造术,9例行小阴唇皮瓣联合中厚皮片法阴道再造。术后随访6个月～2年。结果:16例阴道再造患者皮片及小阴唇瓣均成活,术后阴道可容2～3指,阴道长约8～10cm,小阴唇皮瓣联合游离皮片的手术较单纯游离皮片法时间长,差异具有统计学意义(P<0.05),出血量无统计学意义(P<0.05)。应用小阴唇皮瓣联合游离皮片的方法术后阴道长度及性生活满意率优于单纯游离皮片法(P<0.05),阴道宽度两种方法无明显差异(P>0.05)。结论:两种方法操作简单,易于推广,相对于单纯中厚皮片的方法,小阴唇皮瓣结合皮片阴道再造术皮片不易挛缩,弹性好,腔隙湿润,更加符合生理环境,但是小阴唇瓣受小阴唇发育情况的限制,更适合小阴唇发育好的患者。     

改良阴股沟皮瓣阴道再造术

目的探讨提高阴股沟皮瓣再造阴道的成功率、降低血循环障碍的可能性、避免大阴唇和阴道口明显畸形的治疗方法。方法1998年6月-2004年5月共收治15例患者行阴道再造术。其中男性易性癖2例;女性先天性无阴道13例。年龄23～31岁,平均26.2岁。术前以超声多普勒血流探测仪探及阴道与肛门间水平距中线约3cm处的动脉音,以腹股沟为轴在大阴唇外侧设计大小为12.0cm×5.5cm皮瓣,使动脉穿支位于皮瓣的内下角,皮瓣掀起后在蒂部行部分横断,以利皮瓣移位。造穴后将皮瓣引入形成阴道衬里,蒂部适当修整,对位缝合形成阴道外口。供区直接缝合。结果再造阴道后皮瓣全部成活。14例伤口Ⅰ期愈合;1例男性患者术后阴道后壁近顶部伤口裂开约2cm,对症处理后愈合。供区均Ⅰ期愈合。患者均获随访,随访时间6个月～3年。再造阴道深度可达10cm左右,宽度能容纳2指。1例女性患者术后20个月发现阴道内毛发较为茂密,未行处理。其余患者阴道内壁光滑完整。2例女性患者自述有性生活,应用润滑剂后比较满意。结论经改良的阴股沟皮瓣血运可靠,用于阴道再造时移位方便,阴道口外形满意。     

阴囊皮瓣结合黏膜/皮肤微粒法再造阴道在男变女变性手术中的应用

目的 介绍一种新的男变女变性手术的阴道再造方法.方法 采用阴囊皮瓣结合口腔黏膜、阴茎皮肤及尿道海绵体黏膜混合微粒再造阴道,以带阴茎背血管、神经蒂及部分龟头组织再造阴蒂,剩余阴囊皮瓣再造大阴唇,阴茎皮瓣再造小阴唇及阴道前庭.结果 3例易性癖患者术后效果满意.随访10～ 24个月,无严重并发症发生,再造阴道宽敞、湿润、光滑、有性快感,在性生活中无需润滑剂,外阴形态满意,生活状态良好.结论 阴囊皮瓣结合黏膜/皮肤微粒法再造阴道的新方法,在男变女变性手术中充分利用患者本身的外生殖器材料再造女性生殖器官,简单有效,值得推广.     

纵行腹壁下动脉穿支皮瓣阴道再造术

目的 探讨应用腹壁下动脉穿支皮瓣行阴道再造的新术式. 方法 2007年6月至2008年4月,为5例先天性无阴道、1例阴道癌全切即刻阴道再造患者,应用纵行腹壁下动脉穿支皮瓣行阴道再造术.术前应用增强CT技术选择优势穿支,根据该结果设计皮瓣,大小为(5～6)cm×(18～24)cm. 结果 所有转移皮瓣完全成活.5例患者术后恢复顺利,1例出现会阴切口感染,伤口部分裂开,予以换药愈合.围手术期无明显其他并发症发生.随访1～8个月(平均4个月),再造阴道外口通畅,患者对再造效果满意. 结论 应用纵行腹壁下动脉穿支血管再造阴道是一种安全、可靠的手术方法.     

扩张皮瓣修复眶周软组织缺损睑外翻的预防方法

目的探讨应用扩张皮瓣修复眶周软组织缺损时预防睑外翻的方法及效果。方法 2015年4月至2019年12月,中国医学科学院整形外科医院收治176例眶周软组织病损患者,男79例,女97例,年龄4~53岁,病损范围1 cm×1 cm~6 cm×10 cm。术前根据病损的部位及大小选择合适的扩张器;一期埋置扩张器,按期注水扩张;二期将扩张皮瓣转移覆盖眶周缺损创面,切除部分包膜,并将皮瓣固定于骨膜,恢复眼睑位置与形态,预防睑外翻;术后佩戴弹力头套3~6个月进行塑形。术后对皮瓣成活情况及并发症进行随访。结果 176例患者埋置的扩张器容积为30~400 ml, 扩张时间1~6个月,所获扩张皮瓣大小为3 cm×3 cm~6 cm×9 cm。术后随访2个月至4年,皮瓣全部成活。其中出现睑裂轻度闭合不全13例,为皮肤扩张不充分所致,未影响眼睑功能,患者拒绝再次治疗;下睑外翻8例,包括术后瘢痕挛缩5例,固定皮瓣的线结脱落1例,扩张器长期牵拉使下睑支撑组织松弛2例,其中5例行皮瓣修整术后矫正,3例未再次治疗;其余均获得满意效果。缝线固定皮瓣所留凹陷在术后1~6个月内消失。结论以扩张皮瓣修复眶周软组织缺损时,在术前、术中及术后分别实施针对性的干预措施,以减小或分散扩张皮瓣的回缩力,可最大程度地避免睑外翻发生,获得良好的修复效果。     

以颞浅血管顶支为蒂的扩张头皮岛状瓣再造鬓角的临床研究

目的探讨应用以颞浅血管顶支为蒂的头皮岛状瓣再造鬓角的可行性和临床疗效。方法 2012年2月—2015年4月,收治7例拟再造鬓角患者。男3例,女4例;年龄4~44岁,平均15岁。烧烫伤后瘢痕3例,外伤瘢痕1例,血管瘤同位素放射治疗后瘢痕1例,先天性色素痣2例。鬓角缺损范围为5.0 cm×3.5 cm~16.0 cm×10.0 cm。一期根据鬓角区皮肤软组织缺损大小,在包含颞浅血管顶支的正常头皮组织下埋置皮肤软组织扩张器,术后定期注水扩张;一期术后3~6个月,待扩张头皮达到预期修复所需组织量时,二期手术取出扩张器,切取以颞浅血管顶支为蒂的头皮岛状瓣修复鬓角软组织缺损,皮瓣范围为8 cm×3 cm~17 cm×11 cm。供区直接拉拢缝合。结果术后皮瓣均顺利成活,受区创面及供区切口均Ⅰ期愈合。患者均获随访,随访时间1~36个月,平均9.8个月。再造鬓角形态、毛发密度、毛发生长方向与对侧正常鬓角相似。1例术后皮瓣毛发超出原有发际线,经激光脱毛处理外观满意。结论应用以颞浅血管顶支为蒂的扩张头皮岛状瓣修复鬓角区皮肤软组织缺损,再造鬓角外观与对侧正常鬓角相似,是一种有效修复方法。     

皮下蒂会阴轴型皮瓣再造阴道

目的：探求如何通过手术使再造道形态的功能良好,方法：用含有阴唇后动脉的皮下蒂会阴轴型皮瓣,经小阴唇皮下隧道再造阴道,结果：治疗无天性无阴道患者39例,再造阴道不挛缩,外阴形态自然,功能良好,结论：皮下蒂会阴轴型皮瓣再造阴道,是一种方便有效的方法。     

岛状颞浅血管颈部预制扩张皮瓣修复面部软组织缺损

目的　探讨应用颞浅血管束颈部预制扩张皮瓣修复面部较大软组织缺损的原理及临床应用方法。　方法　 1998年～ 2 0 0 3年 ,对 6例面部瘢痕挛缩的患者 ,将颞浅血管植入颈部扩张皮瓣皮下 ,经 3个月组织扩张 ,形成以颞浅血管为蒂的颈部预制扩张皮瓣 ,移位修复同侧面部软组织缺损。预制扩张皮瓣最大范围为 12 cm× 8cm,蒂长 7～8cm。　结果　术后 6个预制扩张皮瓣 ,移位后有一过性充血潮红 ,均完全成活。修复面颊部及颏部软组织缺损后 ,随访3～ 6个月 ,效果良好。　结论　以颞浅血管颈部预制扩张皮瓣修复面部软组织缺损方法可靠。颞浅血管束与扩张皮瓣接触范围的大小与蒂部所携带皮瓣的面积呈正相关。     

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。     

小阴唇瓣阴道成形术的方法改进

目的：完善小阴唇瓣阴道成形术。方法：2002年9月～2003年9月，对小阴唇瓣阴道成形术进行了改进，并采用改进的手术方法治疗先天性无阴道惠者5例。结果：伤口均Ⅰ期愈合，小阴唇瓣1OO％成活，再造阴道可顺利容纳2指，未发生直肠、尿道及膀胱损伤。术后6～7个月的随访结果表明，小阴唇外形良好，外阴结构满意，2例已成婚，婚后性生活满意。结论：采用改良的小阴唇瓣阴道成形术有助于术后外阴形态的恢复。     

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.     

轴型皮瓣再造阴道126例经验体会

目的：总结6种皮瓣再造阴道的临床经验，方法：应用下腹部皮瓣，脐旁皮瓣、小脐唇皮瓣、阴囊皮瓣、阴茎皮瓣和阴股沟皮瓣再造阴道126例，结果：下腹部皮瓣坏死1例，其余皮瓣全部成活，阴茎皮瓣法发生阴道口狭窄1例，阴股沟皮瓣法有3例阴道变浅，结论：阴股沟皮瓣法距受区最近，转移方便，皮瓣薄，血管神经分丰富，再造的阴道柔软，弹性好，有会阴部部感觉，供区极隐蔽并可直接缝合，是阴道再嘉宾 首选皮瓣。     

小阴唇皮肤粘膜组织瓣再造尿道临床体会

目的:摸索在易性病及两性畸形患者性器官再造时尿道再造提升的方法。方法:在左右小阴唇皮肤粘膜组织上设计横行方向蒂在内侧粘膜面上的皮肤粘膜组织瓣,皮肤粘膜瓣蒂宽1.2~1.5cm,长4~6cm,左右两组织瓣对位缝合形成管状作为提升尿道,并将皮肤粘膜瓣通过皮下隧道固定于耻骨联合中点新尿道口位置。结果:36例阴唇皮肤粘膜组织瓣全部成活,提升尿道排尿顺畅,但有4例患者出现尿瘘并做了而期修补。结论:小阴唇皮肤粘膜组织瓣具有血运丰富、细薄柔嫩、无毛发等特点,是再造尿道时较为理想的组织材料。     

镰状瓣小阴唇整形术

目的：介绍一种治疗小阴唇肥大的手术方法。方法：采用镰状瓣法行小阴唇整形术。保留小阴唇边缘，以小阴唇上部为蒂，去除小阴唇中部一全层组织，形成一上宽下窄的组织瓣。逐层缝合。结果：本组患者32例(55侧)，术后创口均工期愈合。随访时间1至3年，局部无感觉异常，外阴形态满意。结论：镰状瓣小阴唇整形术具有术后瘢痕隐蔽、外阴形态佳，术后感觉正常，是有效治疗小阴唇肥大的较好方法。     

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。     

The split labium minus flap graft technique

The split labium minus flap graft technique was used to restore tissue volume and therefore elasticity into the bladder neck area of vagina in eight patients. Three full-thickness vaginal incisions were made, a longitudinal incision extending from external urethral meatus to 3–4 cm beyond the bladder neck, and two transverse incisions, one just below the external urethral meatus and the other at the level of the bladder neck. The vagina, urethra and bladder neck were mobilized widely and the suburethral flaps rotated downwards, leaving a bare area below the urethra. A transverse incision was made across the base of one labium minus (LM) and the incision carried up on each side to the ridge of the LM. The inner wall was dissected clear of the outer wall, creating a flap. This was then rotated into the bare area formed by dislocation of the suburethral vagina. The flap was attached to the pubococcygeus muscles laterally, to the external meatus superiorly and to the vaginal skin inferiorly. All the cut surfaces of the vagina and LM were joined with 00 Dexon sutures. Postoperative pain was minimal. All patients were discharged within 48 h, and there was excellent anatomical restoration at 6 weeks follow-up. The technique works well in patients with adequately large labia minora, and has potential uses for patients who have deficient vaginal tissue in the hammock or bladder neck areas of the vagina.Abbreviations LM Labium minus Editorial Comment: Tethering of the vagina during vaginal repair may cause overcorrection of the support under the bladder neck. Using a full-thickness graft from the labia minora permits the release of the vagina under the urethra and bladder neck and allows for the closure of the vaginal mucosa without tension.     

Vaginoplasty in male transsexuals using penile skin and a urethral flap

OBJECTIVES: To describe and present the results of a one-stage vaginoplasty in male-to-female sex reassignment surgery. PATIENTS AND METHODS: The present technique is based on penile disassembly and the use of all penile components for vaginoplasty (except the corpora cavernosa). The neovagina consists of two parts; a long vascularized urethral flap and a pedicled island tube skin flap created from the penile skin. The urethral flap is embedded into the skin tube. The tube, consisting of skin and the urethral flap, is inverted, thus forming the neovagina. The new vagina is inserted into the previously prepared perineal cavity between the urethra, bladder and rectum. The neovagina is then fixed to the sacrospinous ligament. The labia minora and majora are formed from remaining penile and scrotal skin. The new method was used in 89 patients (mean age 28 years, range 18-56) with a mean (range) follow-up of 4. 6 (0.25-6) years. RESULTS: Good cosmetic and functional results were obtained in 77 of the 89 patients (87%). Importantly, the neovagina produced in most patients was of satisfactory depth and width. There was only one major complication, a rectovaginal fistula caused by intraoperative injury to the rectum. CONCLUSIONS: The technique produces a vagina with more normal anatomical and physiological characteristics than those produced by other methods, as all the penile components are used (except for the corpora cavernosa) to form almost normal external female genitalia. Vaginoplasty using pedicled penile skin with a urethral flap is a good alternative to other methods of vaginoplasty in male-to-female sex reassignment surgery.     

小阴唇皮瓣法治疗阴道闭锁

目的：探讨小阴唇皮瓣法在先天性阴道闭锁的临床应用。方法：选择适宜的13例先天性阴道闭锁患者,根据阴道缺损的量设计应用部分或完全小阴唇皮瓣进行部分或全阴道再造。结果：所有手术获得成功,再造阴道均通畅,湿润,光滑有弹性,有功能性子宫的病人月经正常,性生活满意,并有3例获正常妊娠分娩。结论：选择小阴唇发育良好的病例应用小阴唇皮瓣法再造阴道,其方法简便,损伤小,无外显瘢痕,费用少,值得在临床选择推广应用。     

Vaginal reconstruction using labia minora flaps in congenital total absence

A simplified technique using labia minora for total lining of the neovagina succeeded in 7 of our 10 patients with encouraging cosmetic and physiological results. In the remaining 3 patients, because of the smaller size of the labia minora, additional free skin grafts were necessary. The surgical technique, especially the surgical anatomy of the labia minora, is described in detail.