Anatomy of genital reaffirmation surgery (male‐to‐female): Vaginoplasty using penile skin graft with scrotal flaps

Saylor, Leah; Bernard, Shenell; Vinaja, Xochitl; Loukas, Marios; Schober, Justine M.

doi:10.1002/ca.23015

Cited by 12 publications

(6 citation statements)

References 13 publications

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“…Pauls () reported that the clitoris has an intricate anatomy; therefore, understanding the clitoral frenulum as the anatomical structure stabilizing the clitoris is important, since the clitoris is considered to be central to female orgasmic responses. Saylor et al () emphasized the need for a clear understanding of female anatomy when male‐to‐female transgender surgery is performed. The surgical precursors of the anatomical structures of the female genitalia were itemized by Saylor et al () as follows: the clitoris is crafted from the glans penis so it retains its innervation; the labia minora are formed using excess penile skin tissue; and the long male urethra is shortened to that of its feminine counterpart.…”

Section: Discussionmentioning

confidence: 99%

“…Saylor et al () emphasized the need for a clear understanding of female anatomy when male‐to‐female transgender surgery is performed. The surgical precursors of the anatomical structures of the female genitalia were itemized by Saylor et al () as follows: the clitoris is crafted from the glans penis so it retains its innervation; the labia minora are formed using excess penile skin tissue; and the long male urethra is shortened to that of its feminine counterpart. The main goal of these reconstructive methods is to create a functionally and esthetically acceptable vagina and vulva, together with expected voiding function and satisfactory sexual function.…”

Section: Discussionmentioning

confidence: 99%

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The Clitoral Infrafrenulum Fascial Bundle: The Anatomy and Histology

Ostrzenski¹

2018

Clinical Anatomy

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To determine whether the clitoral infrafrenulum layer exists. This descriptive observational study was conducted using 15 fresh human female cadavers. Macro and micro stratum-by-stratum anatomical dissections of the clitoral frenulum were performed bilaterally. Target tissue biopsies were obtained for microscopic examination and the specimens were stained with eosin and hematoxylin. The skin folds with erectile tissue between them create the superficial stratum of the clitoral frenulum. The inferior edge of the skin fold is firmly fused with the superficial infrafrenulum fascial bundle, which creates the deep stratum. Histological examination confirmed that the clitoral frenulum comprises two layers: 1) the superficial stratum consists of the dermis, sub-dermis with cutis appendages (sebaceous and apocrine glands) and the squamous mucosa with erectile tissue between the skin folds; 2) the infrafrenulum fascia bundle consists of fibro-connective-adipose tissue with intermittent layers of adipose cells and fibrous bands. The clitoral infrafrenulum fascial bundle exists and creates the deep stratum of the clitoral frenulum. Histologically, the clitoral frenulum consists of two layers, the superficial and deep strata. Both strata form the clitoral frenulum stabilizing mechanism. This anatomical discovery has potential for immediate clinical implementation. Clin. Anat. 31:907-912, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Clitoral Infrafrenulum Fascial Bundle: The Anatomy and Histology

Ostrzenski¹

2018

Clinical Anatomy

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“…Other less-invasive methods have been proposed, including Creatsas vaginoplasty (modified Williams method) [22], the labial and vestibular flap method [23], and the use of a small graft of perineal skin at the introitus to line the distal posterior aspect of the newly created vagina [24, 25]. In gender reassignment surgery, the most commonly used method is penile inversion vaginoplasty with scrotal flaps [26], sometimes combined with autologous buccal micro-mucosa free grafts [27]. However, several techniques have been attempted to cover (and epithelize) the newly formed vagina.…”

Section: Discussionmentioning

confidence: 99%

Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis

et al. 2019

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BackgroundTo evaluate the feasibility and clinical outcomes of vaginoplasties using a neovaginal polylactic acid prosthesis made with 3-dimensional (3D) printing technology as an intraneovaginal mould.MethodsThis was an interventionist, prospective, and multicentre clinical pilot investigation of a sanitary product (PACIENA prosthesis®) aiming to recruit and operate on 8 patients over 6 months with a follow-up period of 6 months. Only six patients with Rokitansky syndrome and one patient with Morris syndrome (7 patients in total) were operated on in two university hospitals: “La Fe”, Valencia (H1) and “Arrixaca”, Murcia (H2). Interventions: Extensive surgical dissection of a defined space between the urethra and bladder in the front and of the rectum in the back as well as insertion of the PACIENA prosthesis® covered with Interceed® were performed. After 12 days, the prosthesis was changed to the silicone-covered version for daily application.ResultsIn the 6 patients with Rokitansky syndrome (86%), the primary endpoint (satisfactory vaginal outcome in terms of appearance, function, and sensation without relevant additional morbidity) was achieved, although only 2 patients (28%) were sexually active at the end of 6 months of follow-up. The patient with Morris syndrome withdrew from the study after 1 month. Patients without bacterial colonization showed positive Schiller tests at 1 month, and subsequent biopsies showed adequate keratinization and epidermization. Epithelization and iodopositivity were delayed in the patients who developed inflammatory granulomas.ConclusionsGood anatomical and functional results can be achieved with the PACIENA prosthesis® for vaginoplasties without skin grafts. However, adequate patient selection and education, good surgical techniques and haemostasis, postoperative support, and prevention of bacterial colonization are important.Trial registrationThis clinical study was approved by the Ethical Clinical Investigation Committee of San Juan University Hospital on September 27, 2016, to be conducted in the participating centres; it was authorized by the Spanish Agency of Medicines and Health Products (AEMPS) on April 24, 2017 (exp. no. 585/16/EC), to be carried out in that hospitals.

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“…Journal of South Asian Federation of Obstetrics and Gynaecology, Volume 14 Issue 3 (May-June 2022) cultured vaginal tissue, 12 and labial or gracilis flaps [13][14][15][16] have all been used for the McIndoe procedure.…”

Section: Autologous In Vitromentioning

confidence: 99%

Comparative Study of Creation of Neovagina Using Skin Graft and Interceed in Mayer–Rokitansky–Küster–Hauser Syndrome

Dixit¹,

Bhalerao²,

Mehta³

et al. 2022

Journal of South Asian Federation of Obstetrics and Gynaecology

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Objective: This study compared and evaluated the outcomes of using Interceed and skin graft in vaginoplasty for women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome on the basis of vaginal length (neovagina), procedure safety, patient satisfaction (sexual) after marriage, ease of procedure, procedure time, and morbidity. Materials and Method: Over the course of 18 months, this hospital-based randomized controlled trial was conducted at a tertiary care center. There were 17 women with primary amenorrhea and MRKH syndrome who had undergone vaginoplasty and met the inclusion and exclusion criteria. Nine women received vaginoplasty with Interceed and eight women got vaginoplasty with skin graft, and they were monitored for 6 months postmarriage using a computerized block randomization system. Anatomical and functional outcomes were assessed in these women. The percentage, mean, and standard deviation (SD) were calculated using Epi Info program. For the analysis, the Mann-Whitney and Fischer tests were used. Observations: Women in group A (Interceed) were 22.322 ± 1.59 years old, whereas those in group B (split-thickness skin transplant) were 23.85 ± 1.83 years old. On day 8, the length of the vagina in women who had vaginoplasty with Interceed (Group A) was 8.8330.4153 cm, which was longer than 8.413 ± 0.4190 cm in women who had split-thickness skin transplant (Group B). The vaginal width was determined to be two-finger breadth in both groups. The duration of surgery in women undergoing vaginoplasty with Interceed (Group A) was 32 ± 4.243 minutes as compared to split-thickness skin graft (Group B) where it was 61.38 ± 8.634 minutes. This difference is statistically significant. The functional outcome in relation to sexual satisfaction (lubrication, orgasm, satisfaction, and pain) in women undergoing vaginoplasty with Interceed was 77.8% as compared to 37.5% with Split-thickness skin graft. Conclusion: By using Interceed for vaginoplasty, gynecologist is independent and no separate procedure is required for graft. It is safe, easy, effective, less time-consuming and patient satisfaction with anatomical and functional outcome is good due to squamous epithelization. Hence, is a potential alternative for vaginal agenesis.

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Anatomy of genital reaffirmation surgery (male‐to‐female): Vaginoplasty using penile skin graft with scrotal flaps

Cited by 12 publications

References 13 publications

The Clitoral Infrafrenulum Fascial Bundle: The Anatomy and Histology

The Clitoral Infrafrenulum Fascial Bundle: The Anatomy and Histology

Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis

Comparative Study of Creation of Neovagina Using Skin Graft and Interceed in Mayer–Rokitansky–Küster–Hauser Syndrome

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