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Horse shoe flap vaginoplasty—a new technique of vaginal reconstruction with labia minora flaps for primary vaginal agenesis

  • V. Purushothaman
    Correspondence
    Address: AA 55, 2nd Street, Anna Nagar, Chennai 600 040, India. Tel.: +91 44 2621 3611.
    Affiliations
    Apollo's National Institute for Reconstructive Hand Surgery, Micro Surgery and Plastic Surgery, Apollo First Med Hospital, 154, P.H. Road, Chennai 600 010, India
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      Summary

      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.

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      References

        • Tarry W.F.
        • Duckett J.W.
        • Doughlas F.
        The Mayer–Rokitansky syndrome: pathogenesis, classification and management.
        J Urol. 1986; 136: 648
        • Goldwyn R.M.
        History of attempts to form a vagina.
        Plast Reconstr Surg. 1977; 59: 319
        • Sakurai H.
        • Nozaki M.
        • Sasaki K.
        • Nakazawa H.
        The use of free jejunal autograft for the treatment of vaginal agenesis: surgical methods and long-term results.
        Br J Plast Surg. 2000; : 319-323
        • Ozgenel G.Y.
        • Ozcan M.
        Neovaginal construction with buccal mucosal grafts.
        Plast Reconstr Surg. 2003; 111: 2250-2254
        • Hockel M.
        • Menke H.
        • Germann G.
        Vaginoplasty with splint skin grafts from the scalp: optimization of the surgical treatment for vaginal agenesis.
        Am J Obstet Gynaecol. 2003; I88: 1100
        • Chen Y.-B.
        • Cheng T.-J.
        • Lin H.-H.
        • Yang Y.-S.
        Spatial W-plasty full-thickness skin graft for neo vaginal reconstruction.
        PRS. 1994; 94: 727
        • O'Brien B. McC.
        Treatment of vaginal agenesis with a new vulvovaginoplasty.
        PRS. 1990; 85: 942-948
        • Hagerty R.C.
        • Vuaghn T.R.
        • Lutz M.H.
        The Perineal artery axial flap in reconstruction of the vagina.
        Plast Reconstr Surg. 1988; 82: 344-345
        • Giraldo F.
        • Solano A.
        • Mora M.J.
        • Abehsera M.
        • Gonzalez C.
        • Rus J.A.
        The malaga flap for vaginoplasty in the Mayer–Rokitansky–Kuster–Hauser syndrome experience and early-term results.
        Plast Reconstr Surg. 1996; 98: 305-312
        • Giraldo F.
        • Mora M.J.
        • Solano A.
        • Abehsera M.
        • Ferron M.
        • Smith J.M.
        Anatomic study of the superficial perineal neurovascular pedicle: implications in vulvoperineal flap design.
        Plast Reconstr Surg. 1997; 99: 100-108
        • Giraldo F.
        • Gaspar D.
        • Gonzalez C.
        • Bengoechea M.
        • Ferron M.
        Treatment of vaginal agenesis with vulvoperineal fascio cutaneous flaps.
        PRS. 1994; 93: 131-140
        • Giraldo F.
        Cutaneous neovaginoplasty using the malaga flap (vulvoperineal facio cutaneous flap): a 12 year follow up.
        PRS. 2003; 111: 1249-1255
        • Wee and Joseph of Singapore
        A new technique of vaginal reconstruction using neurovascular pudendal thigh flaps.
        PRS. 1989; 83: 701-709
        • Woods J.E.
        • Alter G.
        • Meland B.
        • Podratz K.
        Experience with vaginal reconstruction utilizing the modified Singapore flap.
        Plast Reconstr Surg. 1992; 90: 270-274
        • Yii N.W.
        • Niranjan N.S.
        Lotus petal flaps in vulvo-vaginal reconstruction.
        Br J Plast Surg. 1996; 49: 547-554
        • Flack C.E.
        • Barraza M.A.
        • Stevens P.S.
        Vaginoplasty: combination therapy using labia minora flaps and lucite dilators—preliminary report.
        J Urol. 1993; 150: 654-656