Passerini-glazel feminizing genitoplasty: modifications in 17 years of experience with 82 cases

OBJECTIVES: To describe modifications of Passerini-Glazel feminizing genitoplasty and report on long-term functional outcome. METHODS: Modifications include vaginal dissection and disconnection from the urethrovaginal sinus as the initial stage of the procedure; large dissection of the neurovascular bundle on both dorsal and lateral faces of the clitoris; plication of the skin around the reduced clitoris; and suturing the lateral edge of the proximal portion of the mucocutaneous plate with the labia majora's medial edge to a plane deeper than the subcutaneous tissue. These modifications reduce bleeding and operating time, better preserve clitoral sensitivity, form the clitoral prepuce, and create labia minora. RESULTS: Eighty-two patients underwent modified Passerini-Glazel feminizing genitoplasty. Mean operating time was 120min (range: 100-180). Forty-six patients (46 of 82, 56%) were assessed at a mean follow-up of 5 yr (range: 2-9). There were no cases of clitoral vascularization defect or urethrovaginal fistula. The urethral meatus was never hypospadic. The vaginal introitus was large and elastic in all cases. Vaginal caliber at the internal suture line was as large as the vaginal introitus and the distal native vagina in 20 (43.5%) of the 46 girls. All mothers and patients reported satisfaction with external genital appearance. CONCLUSIONS: These long-term results suggest that our modifications of one-stage Passerini-Glazel feminizing genitoplasty facilitate the procedure and produce good cosmetic results.     

Single-stage feminizing genitoplasty in aphallia through an anterior saggital approach

Purpose

An ideal feminizing genitoplasty in aphallia should achieve good cosmesis and capacious vagina in a single-stage repair. Most of the techniques described in the literature are variations of the posterior sagittal approach with staged repair. We describe a single-stage anterior sagittal approach for feminizing genitoplasty in cases of aphallia.

Materials and Methods

A case of aphallia was operated through an anterior sagittal approach, and a spiral Monti tube of sigmoid colon was used to create a neovagina. Preservation of the skin tag around the urethra and its placement in the perineum gives it the appearance of the clitoris.

Result

The patient has been observed for 7 months. She is continent and has a satisfactory cosmetic appearance and capacious vagina.

Conclusion

A single-stage operation through an anterior sagittal approach is a good alternative technique for genital reconstruction in the case of aphallia.     

Genital sensation after feminizing genitoplasty for congenital adrenal hyperplasia: a pilot study

OBJECTIVE: To assess sensation in the clitoris and vagina in women with congenital adrenal hyperplasia (CAH) who have previously had genital surgery, and to evaluate sexual function in this group as the latter, and particularly the experience of orgasm, appear to be closely related to sensitivity. PATIENTS AND METHODS: Six women were recruited from a multidisciplinary clinic specialising in intersex conditions, and representing an initial cohort from a larger ongoing study. The patients were asked to complete a postal questionnaire with a specialized sexual function assessment. Thermal, vibratory and light-touch sensory thresholds were assessed in the clitoris and vagina using a genito-sensory analyser and Von Frey filaments. RESULTS: All six women had highly abnormal results for sensation in the clitoris. Only three of them had an introitus capable of admitting the vaginal probe, and the vaginal sensory data of all three were within the validated ranges. A self-administered sexual function assessment was completed by the five women who were sexually active. The scores indicated sexual difficulties, particularly in the areas of infrequency of intercourse and anorgasmia. CONCLUSIONS: The sensory data for all six women were outside the normal range for the clitoris. The results for the upper vagina, which had not had surgery, were within normal ranges. These findings suggest that genital surgery may disrupt sensory input. Sexual function also appears to be impaired and this may relate to the compromised sensitivity and restricted introitus. The possibility that women with CAH have deficient clitoral sensation ab initio cannot be excluded. These striking findings must be evaluated further in the light of the controversy about the issue of genital surgery in children with CAH.     

The superficial temporal venous island flap for eyebrow reconstruction

A case in which a venous island flap was used for eyebrow reconstruction is presented. This flap was based on the anterior superficial temporal vein.     

手部神经血管蒂皮瓣的临床应用

我院自1962年5月至1992年1月,应用手部神经血管蒂皮瓣72例,其中指神经血管蒂皮瓣38例,示指背侧岛状皮瓣(第1掌骨背动脉)24例,手背第Ⅱ掌骨背动脉皮瓣7例,小鱼际皮瓣3例,修复手部皮肤缺损。术后除1例指神经血管蒂皮瓣失败外,余均成活,经1个月～12年随访功能优良率为94.4%。我们在文中介绍了各种皮瓣的优缺点,皮瓣设计,手术要点,并讨论了皮瓣的解剖学规律及手术适应证。     

手部神经血管蒂皮瓣的临床应用

我院自１９６２年５月至１９９２年１月，应用手部神经血管蒂皮瓣７２例，其中指神经血管蒂皮瓣３８例，示指背侧岛状皮瓣（第Ⅰ掌骨背动脉）２４例，手背第Ⅱ掌骨背动脉皮瓣７例，小鱼际皮瓣３例，修复手部皮肤缺损。术后除１例指神经血管蒂皮瓣失败外，余均成活，经１个月～１２年随访功能优良率为９４．４％。我们在文中介绍了各种皮瓣的优缺点，皮瓣设计，手术要点，并讨论了皮瓣的解剖学规律及手术适应证。     

指动脉皮瓣与超薄腹部皮瓣在末节指再造中的联合应用

目的探讨指动脉岛状皮瓣与超薄腹部皮瓣在末节指再造中联合应用的临床治疗效果。方法指动脉岛状皮瓣转位置于掌侧,超薄任意腹部皮瓣修复大部分缺损创面,进行末节拇、手指再造10例。结果再造指全部成活,经5～12个月随访,2例需二期整形,再造指腹、指端两点辨别觉6-10mm,外形及功能满意。结论指动脉岛状皮瓣与超薄腹部皮瓣联合应用为末节指再造提供一种较实用的方法。     

顺行岛状静脉皮瓣的临床应用

为达到修复肢体远端组织缺损时不损伤其主干动脉的目的,设计以浅静脉干远端为蒂的顺行岛状静脉皮瓣。临床应用6例,结果5例成活,1例坏死。结论认为静脉岛状皮瓣成活过程比较复杂,严格选择适应证,采用促活措施是此类皮瓣成活的关键。     

A trial on subcutaneous pedicle island flap for eyebrow reconstruction

Introduction

Severe burn is a common problem affecting victim's eyebrows. This study aims to assess the effectiveness, complications and patients’ satisfaction in two eyebrow reconstruction surgical methods. Up to now, many reconstruction methods, their specific advantages and complications have been introduced. This study compares a new method (subcutaneous pedicle island flap), which is scarcely discussed, with a standard method (superficial temporal artery island flap).

Method

This is a clinical trial conducted during 2003–2005 at the Al’ Zahra’ Hospital. Forty patients with eyebrow defect due to burn injuries were selected by convenience sampling. They were allocated to two groups randomly. The control group underwent a surgery for ‘superficial temporal artery island flap’ and the case group for ‘subcutaneous pedicle island flap’. Data were gathered using two questionnaires. The first one included demographic data, patient history and condition of the eyebrows prior to surgery, effectiveness of surgery and complications. The second was a smiley face visual scale for patient's satisfaction. Data analysis was done using SPSS software (version 12; SPSS Inc., Chicago, IL, USA).

Result

Findings showed that in the control group, 80% were female of a mean age of 22 years (SD = 6/30) and in the case group 75% were female, of a mean age of 21/80 years (SD = 8/28). Fisher's exact test showed a significant difference between the type of surgery and hair-growth direction (p = 0.003). In addition, Mann–Whitney U test showed a significant difference between the type of surgery and patient satisfaction (p = 0.002). Analysis showed that there is no significant difference between the type of surgery and bleeding, congestion, flap necrosis, temporary hair loss in flap and donor-site alopecia (p > 0.05). Surgeon's experience shows that surgery time and learning curve in the case group is lower than that in the control group.

Discussion

Subcutaneous pedicle island flap is an appropriate and easy method with good efficacy, lower complication and more reasonable and acceptable patient's satisfaction. Therefore, this method is recommended for burn patients with eyebrow defects.     

包皮横行岛状皮瓣尿道成形术治疗先天性尿道下裂

目的探讨改良包皮横行岛状皮瓣术(transverse preputial tubularized island flap,TPIF)治疗先天性尿道下裂的方法和效果。方法对77例不同类型的先天性尿道下裂采用改良TPIF进行治疗。结果77例中一次手术成功73例,3例术后发生尿瘘,1例术后再次出现阴茎下屈。随访1至6年,阴茎外观和排尿功能均满意。结论改良包皮横行岛状皮瓣术是先天性尿道下裂较为理想的手术方式,术后外观和功能均令人满意。     

应用岛状颊肌粘膜瓣修复腭裂初步报告

目的：介绍应用岛状颊肌粘膜瓣修复腭裂的临床实践。方法：应用裂缘葶粘骨膜瓣闭合硬腭裂隙的鼻腔侧、软腭后推、软腭鼻侧粘膜Z成形术延长、腭帆提肌吊带重建,再以蒂在后的血管神经蒂岛状颊肌粘膜瓣修复软腭后推后在腭部遗留的横行创面和硬腭裂隙的口腔侧创面。结果：1997年以来共治疗12例,术后岛状颊肌粘膜瓣完全成活,软腭延长显著,无腭瘘形成,无血肿、感染、肋腺导管和面神经损伤及开口功能障碍等并发症发生。结论：岛状颊肌粘膜瓣血运好,易成活;术后早期不需配戴牙垫,不影响恒磨牙的萌出,不干扰咬合,无埯断蒂,不破坏翼下颌皱襞形态和结构,供区易于缝合,感觉功能好。     

Reverse digital artery island flap in the elderly

The following case report illustrates the successful use of the reverse digital artery island flap in elderly patients. The reverse digital artery island flap is a recognised method of providing good quality soft tissue cover to the amputated fingertip. First described in 1986 by Kojima, Lai and Han have reported their experience of 52 and 120 of these flaps, respectively. The majority of patients in the literature are less than 50 years old, with ages ranging from 3 to 62 years. The flap is based upon reversed flow in the digital artery via a communicating branch from the contralateral artery at a point 5mm proximal to the distal interphalangeal joint crease. In the two cases reported below, we have shown that the indications for this type of homodigital flap reconstruction for fingertip amputations can be safely extended to elderly patients.     

颏下岛状瓣修复面部组织缺损

目的探讨颏下岛状瓣修复面部组织缺损的应用效果。方法6例面部病变患者,其中男4例,女2例;最小年龄44岁,最大78岁。病变部位:左面部2例,左腮腺区1例,右腮腺区1例,右面部2例。病变性质:皮样囊肿感染伴皮肤坏死1例,皮脂腺囊肿感染伴皮肤坏死1例,皮肤上皮瘤恶变1例,鳞状细胞癌3例。良性病变切除后,恶性病变扩大切除同期行颈淋巴清扫术后,面部缺损均以颏下岛状瓣即时修复。组织缺损范围最小4.0cm×3.0cm,最大6.0cm×6.0cm。组织瓣最小面积4.5cm×3.0cm,最大6.0cm×4.5cm。组织瓣以颏下动脉为蒂3例,颏下动脉联合面动脉为蒂3例。蒂的长度:6cm3例,9cm2例,11cm1例。结果6例组织瓣均存活良好,肤色与面部无明显差异;未发生任何并发症。供区伤口Ⅰ期愈合,平视位时,供区瘢痕不显露。结论颏下岛状瓣修复面部组织缺损是一种可供选择的良好方法。     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

Intraoral reconstruction with latissimus dorsi myocutaneous island flap

Summary Intraoral reconstruction for large defects using a latissimus dorsi myocutaneous island flap in ten patients is presented. All flaps were transferred successfully in one stage and provided adequate flap tissue for the intraoral defect. Five cases involved hemiglossectomy. The postoperative atrophy of the flap was minor and the intraoral defects were adequately resurfaced. The postoperative function of the remaining tongue was satisfactory. The latissimus dorsai myocutaneous flap was found to be reliable and useful for intraoral reconstruction.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.