Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-K€ uster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth. Design: Stepwise demonstration of the procedure with narrated video footage. Setting: Transgender health clinic. Interventions: A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period. Conclusion: Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.
La cirugía de afirmación de género es un campo de cirugía reconstructiva, que se practica en todo el mundo; No obstante, en Colombia, es un procedimiento que se ha realizado pocas veces con resultados catastróficos en la mayoría de los casos, debido a la falta de experiencia, a la ausencia de un protocolo adecuado para evaluación de la salud mental, o una combinación de muchos otros aspectos. En el Centro Especializado de Cirugía Mamaria y Cirugía Transgénero de Cali, el equipo quirúrgico ha realizado 23 casos exitosos de cirugía de afirmación de género Hombre a Mujer, siguiendo las “Normas de atención para la salud de personas con género no conforme”, de la Asociación Mundial de Profesionales para la Salud Transgenero (WPATH, por sus siglas en inglés) con buenos resultados funcionales y estéticos comparables con los resultados que se han publicado sobre el tema en la literatura mundial.
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