Flaps versus skin grafts in neovagina creation for vaginal agenesis

Authors

DOI:

https://doi.org/10.18203/2349-2902.isj20203239

Keywords:

Absence of vagina, Creation, Cosmetic appearance, Mullerian agenesis, Reconstructive surgical procedures, Skin graft, Vaginal cavity

Abstract

Background: Women with congenital uterovaginal agenesis have normal development of all secondary sexual characteristics. They face the cruel fact of being unable to bear children and enjoy sexual satisfaction. Good neo vaginal reconstruction is important in improving functional and psycho social impacts to womanhood. The aim of the study was to compare the three commonly done surgical procedures for vaginal reconstruction.

Methods: All the vaginal agenesis patients who attended Department of plastic surgery Madras Medical College, Chennai during the period from August 2004 to April 2007 were included in our study.

Results: In Abbe McIndoe procedure, graft take was full in all 7 cases with good cosmetic appearance. Flaps survived in all 10 patients underwent pudendal thigh flap surgery. 2 patients underwent horse shoe shaped labia minora flaps. The cosmetic appearance was fair because of the distortion of the labia. The mean vaginal depth obtained was 8 cm and width was 2 cm.

Conclusions: Cosmetic appearance was good in patients who underwent McIndoe procedure as the genitalia were not distorted. Contracture rate was more in patients who underwent McIndoe procedure especially who were irregular in using stents. Flap procedure especially pudendal thigh flaps which has the least contraction rate is the preferable treatment option for such patients.

 

Author Biography

Prabhakar Ulaganathan, Department of Plastic, Reconstructive and FacioMaxillary Surgery, Madras Medical College, Chennai, India

senior civil surgeon,department of plastic surgery.

References

Fliegner JR. Congenital atresia of the vagina. Surg Gynecol Obstet. 1987;165(5):387-91.

Evans TN, Poland ML, Boving RL. Vaginal malformations. Am J Obstet Gynecol. 1981;141(8):910-20.

Jones KL. Noonan syndrome (Turner-like syndrome). In: Smith’s recognizable patterns of Human malformation 4th ed. Philadelphia WB Saunders; 1988:122-123.

Tarry WF, Duckett JW, Stephens FD. The Mayer-Rokitansky syndrome: pathogenesis, classification and management. J Urol. 1986;136(3):648-52.

Rock JA, Breech LL. Surgery for anomalies of the mullerian ducts. In: Rock JA, Jones III HW, eds. TeLinde’s Operative Gynecology. 50th ed. New York Lippincott-Raven; 1997:687-729.

Prabhakar U. A Study on Reconstructive Options for Vaginal Agenesis (Doctoral dissertation, Madras Medical College, Chennai). 2007.

Ingram JM. The bicycle seat stool in the treatment of vaginal agenesis and stenosis: a preliminary report. Am J Obstet Gynecol. 1981;140(8):867-73.

Roberts CP, Haber MJ, Rock JA. Vaginal creation for müllerian agenesis. Am J Obstet Gynecol. 2001;185(6):1349-53.

Alessandrescu D, Peltecu GC, Buhimschi CS, Buhimschi IA. Neocolpopoiesis with split-thickness skin graft as a surgical treatment of vaginal agenesis: retrospective review of 201 cases. Am J Obstet Gynecol. 1996;175(1):131-8.

Seccia A, Salgarello M, Sturla M, Loreti A, Latorre S, Farallo E. Neovaginal reconstruction with the modified McIndoe technique: a review of 32 cases. Ann Plast Surg. 2002;49(4):379-84.

Mcindoe A. Treatment of congenital absence and obliterative conditions of vagina. Br J Plast Surg. 1950;2:254-67.

Counseller VS, Flor FS. Congenital absence of the vagina: further results of treatment and a new technique. Surg Clin North Am. 1957;37(4):1107-18.

Strickland JL, Cameron WJ, Krantz KE. Long-term satisfaction of adults undergoing McIndoe vaginoplasty as adolescents. Adolesc Pediatr Gynecol. 1993;6(3):135-7.

Buss JG, Lee RA. McIndoe procedure for vaginal agenesis: results and complications. Mayo Clin Proceed. 1989;64:758-61.

Cali RW, Pratt JH. Congenital absence of the vagina: long-term results of vaginal reconstruction in 175 cases. Am J Obstet Gynecol. 1968;100(6):752-63.

Ortiz-Monasterio F, Serrano A, Barrera G, Araico J. Congenital absence of the vagina: long-term follow-up in 21 patients treated with skin grafts. Plast Reconstr Surg. 1972;49(2):165-70.

Rock JA, Reeves LA, Retto H, Baramki TA, Zacur HA, Jones HW. Success following vaginal creation for Müllerian agenesis. Fertil Steril. 1983;39(6):809-13.

Hwang WY, Chang TS, Sun P, Chung TH. Vaginal reconstruction using labia minora flaps in congenital total absence. Ann Plast Surg. 1985;15(6):534-7.

Feroze RM, Dewhurst CJ, Welply G. Vaginoplasty at the Chelsea hospital for women: a comparison of two techniques. BJOG Int J Obstet Gynaecol. 1975;82(7):536-40.

Liu Y, Li S, Li Y. Applied anatomic study of the pudendal-thigh flap and establishment of flap model. Zhonghua zheng xing wai ke za zhi= Zhonghua zhengxing waike zazhi= Chinese J Plast Surg. 2001;17(5):272-5.

Wee JT, Joseph VT. A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report. Plast Reconstr Surg. 1989;83(4):701-9.

Li S, Liu Y, Li Y. Twelve cases of vaginal reconstruction using neurovascular pudendal-thigh flaps. Zhonghua Fu Chan Ke Za Zhi. 2000;35(4):216-8.

Khazanchi RK, Takkar D. Vaginal depth following reconstruction with pudendal thigh flaps in congenital vaginal atresia. Plast Reconstr Surg. 1997;99(2):592-3.

Giraldo F, Solano A, Mora MJ, Smith V. Hair growth in the vagina after reconstruction with pudendal thigh flaps in congenital vaginal agenesis. Plast Reconstr Surg. 1998;102(3):924-5.

Karacaoglan N. Hair growth in the vagina after reconstruction with pudendal thigh flaps in congenital vaginal agenesis. Plast Reconstr Surg. 1997;100(6):1618.

Selvaggi G, Monstrey S, Depypere H. Creation of a neovagina with use of a pudendal thigh fasciocutaneous flap and restoration of uterovaginal continuity. Fertil Steril. 2003;80(3):607-11.

Purushothaman V. Horse shoe flap vaginoplasty- a new technique of vaginal reconstruction with labia minora flaps for primary vaginal agenesis. Br J Plast Surg. 2005;58(7):934-9.

Flack CE, Barraza MA, Stevens PS. Vaginoplasty: combination therapy using labia minora flaps and Lucite dilators- preliminary report. J Urol. 1993;150(2):654-6.

Chen Z, Chen C, Chen M, Zhang J, Wu N, Wang J. Vaginal reconstruction using perineal-thigh flaps with subcutaneous pedicle. Chinese Med Sci J= Chung-Kuo I Hsueh K’o Hsueh Tsa Chih. 1991;6(1):14-7.

Gürlek A. The versatility of the pudendal thigh fasciocutaneous flap used as an island flap. Plast Reconstr Surg. 2002;109(1):402-3.

Li GZ, Cheng XD, Zhao TL, Xu J, Ge SX, Wang HG, et al. Experience of vaginal reconstruction by using a pudendal-thigh island flaps. Zhonghua zheng xing wai ke za zhi= Zhonghua zhengxing waike zazhi= Chinese J Plast Surg. 2003;19(3):183-5.

Contreras JS, Romero IP, Mancera JC, Vivar LEH. Surgical correction of vaginal agenesis. Ginecol Obstet Mex. 2006;74(01):37-47.

Downloads

Published

2020-07-23

Issue

Section

Original Research Articles