VAGINOPLASTY WITH BILATERAL ISLANDED PUDENDAL THIGH FLAPS

Samira Ajmal, Kanwal Yusuf

Abstract


Background: Vaginal agenesis is the most common congenital deformity of female pelvis and vaginal
reconstruction remains a surgical challenge. There are various surgical and non-surgical techniques
described for the reconstruction of neovagina. We have used pudendal thigh flaps raised on either side
of the labia to reconstruct the vagina in 19 patients. This study is carried out in the Department of
plastic and reconstructive surgery, Hayatabad medical complex Peshawar to evaluate the functional and
aesthetic outcome of vaginoplasty with bilateral pudendal thigh flaps. Methods: Vaginal reconstruction
was done with bilateral islanded pudendal thigh flaps, in 19 consecutive patients with vaginal atresia,
during 5 years, from Aug 2004 to Aug 2009. The flaps were raised on either side of labia and sutured to
each other in midline to form a vaginal tube. This neo-vagina was inserted into the space between the
rectum and bladder and anchored to the deep pelvic tissues. Results: Out of 19, eleven patients (58%)
were diagnosed with Mayer Rokitansky Kauser Hauser Syndrome and 8 (42%) with isolated vaginal
atresia. The mean vaginal length and width was 9.2 and 4.3 cm respectively one year post operatively.
Conclusion: This method of vaginoplasty is simple, safe, and reliable and has shown satisfactory
functional and cosmetic results. The reconstructed vagina has a natural angle and is sensate in its lower
part. No postoperative stenting or dilatation is required. The donor site in the groin can be closed
primarily and the scar is well hidden in the groin crease.
Keywords: Vaginoplasty, vaginal reconstruction, vaginal atresia, pudendal thigh flaps

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References


Friedman J. Reconstruction of perineum. In: Grab and smith’s

Plastic Surgery. 6th ed. Phildelphia: Lipponcott-Reven; 2007. p.

–16.

Tahmeedullah, Khan TA, Obaidullah. Functional outcome of

Horton`s Vaginoplasty. J Coll Physicians Surg Pak

;13:596–9.

Oppelt P, Renner SP, Keller-Mann A, Brucker S, Hauser GA,

Ludwig KS, et al. Clinical aspects of Mayer-Rokitansky-KuesterHauser syndrome: Recommendations for clinical diagnosis and

staging. Hum Reprod 2006;21:792–7.

Morcel K, Camborievx L. Mayer-Rokitansky-Kauster-Hauser

syndrome. Orphanet J Rare Dis 2007;2:13.

Folch M, Pigem I, Konje JC. Mullerian agenesis: etiology,

diagnosis, and management. Obstet Gynecol Surv

;55:644–9.

J Ayub Med Coll Abbottabad 2010;22(1)

http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Samira.pdf

Griffin JE, Edwards C, Madden JD, Harrod MJ, Wilson JD.

Congenital absence of the vagina. The Mayer-RokitanskyKuster-Hauser syndrome. Ann Intern Med 1976;85:224–36.

Acien P, Acien M, Sanchez-Ferrer M. Complex malformations

of the female genital tract. New types and revision of

classification. Hum Reprod 2004;19:2377–84.

Frank RT. The formation of an artificial vagina without

operation. Am J Obstet Gynecol 1938;35:1053–60.

Thompson JD, Warton LR, Te-Linde RW. Congenital absence of

vagina: an analysis of 32 cases corrected by McIndoe operation.

Am J obstet Gynecol 1957;74:397–84.

Lesavoy MA, Carter EJ. Reconstruction of female genital

defects: Congenital. In: Methes SJ (Editor) Plastic surgery .2nd ed.

Phildelphia: Saunders; 2006. p.1281–92.

Tosun Z, Hosnuter M, Savaci N, Capar M, Senturk S. Experience

with vaginoplasty. Scand J Plast Reconstr Surg Hand Surg

;38:27–31.

Li S, Liu Y, Li Y. Twelve cases of vaginal reconstruction using

neurovascular pudendal thigh flaps. Zhonghua Fu Chan Ke Za

Zhi 2000;35:216–8.

Emiroglu M, Gultan SM, Adanali G, Apaydin L, Yormu KE.

Vaginal reconstruction with free jejunal flap. Ann Plast Surg

;36:316–20.

McCraw, JB, Massey, FM, Shanklin, KD, Horton CE. Vaginal

reconstruction with gracilis myocutaneous flaps. Plast. Reconstr.

Surg 1976;58:176–83.

Essien J, bardales J. Mayer Rokitansky-kuster-Hauser Syndrome

in A caribean population: A case report. Internet J Gynecol

Obstet 2005;5:1.

Giraldo F. Follow up. Cutaneous neovaginoplasty using the

Malaga Flap (Vuloperineal Fasciocuteous flap): A 12 years

follow-up. Plast Reconstr Surg 2003;111:1249–55.

Buss JG, Lee RA. Mcindoe prodcedure for vaginal agenesis;

results and complication. Mayo clin proc 1989;64:758–61.

Namba Y, Suqyama N, Yamashita S, Haseqawa K, Kimata Y,

Nakatsuka M. Vaginoplasty with Pudendal high flap in

intersexuals. Acta Med Okayama 2008; 62:415–9.

Baytekin C, Menderes A, Mola F, Balik O, Tayfur V, Vayvada

H. Total vaginal reconstruction with combined “split Labia

minora flaps” and full thickness skin graft. J Obstet Gynecol Res

;33:524–8.

Li GZ, Cheng XD, Zhao TL, Xu J, Ge SX, Wang HG, Li XW.

Experience of vaginal reconstruction by using a pudendal-thigh

island flap. Zhonghua Zheng Xing Wai Ke Za Zhi

;19:183–5.

He Q, Lin Z, Liu Q. One-stage vagina reconstruction using the

pudendal-thigh skin flap. Zhonghua Zheng Xing Shao Shang

Wai Ke Za Zhi 1998;14:3–5.

Goldwyn RM. History of attempts to from vagina. Plast Reconstr

Surg 1977;59:319.

Wee JTK, Joseph VT. A new technique of vaginal reconstruction

using neurovascular Pudendal thigh flap: A preliminacy report.

Plast Reconstr Surg 1989;83:701–9.

Hagarty RC, Vaughn TR, Lutz MH. The Perineal artery axial

flap in reconstruction of the vagina. Plast Reonstr Surg

;82:344–5.

Giraldo F, Gonzalalez C. The versatility of Pudendal thigh

fasciocutaneous flap used as an island flap. Plast Reconstr

Surg 2001;108:2172–4.

Stan M, Phillip B, Koenraad VL, Alexis V, Patrick T, Guido

M. The versatility of pudendal thigh flap used as an island flap.

Plast Reconstr Surg 2001;107:719–24.

Khanzanchi RK, Takkar D. Vaginal depth following

reconstruction with Pudendal high flaps in congenital vaginal

atresia. Plast.Reconstr. Surg 1997;99:592–3.

Ganatra MA, Ansari NU. Pudendal thigh flap for congenital

absence of vagina. Pak Med Assoc 2005;55:143–5.

Davies MC, Creighton SM, Woodhouse CRJ. The pitfalls of

vaginal reconstruction. BJU International 2005;95:1293–8.

Schult M, Wolters HH, Lelle RJ, Winde G, Senninger N.

Outcome of surgical intervention for rectoneovaginal fistulas

in Mayer-Rokitansky-Kuester-Hauser syndrome. World J

Surg 2001;25:438-40

Gleeson NC, Bailew, Robert WS, Hoffman MS, Fiorica JV,

Finan MA, et al. Pudendal thigh fasciocutaneous flaps for

vaginal reconstruction in gynecologic oncology. Gynecol Oncol

;54:269–74.


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