Experience With Neovaginal Construction Using the Full-Thickness Skin Graft in Vaginal Agenesis

Abstract

The correction of vaginal agenesis requires the creation of a neovaginal cavity that is dissected between the bladder and the rectum. To protect the length of the cavity, it is necessary to ensure the complete epithelialization of the apex of the neovaginal cavity. The author prefers to tailor 2 pieces of full-thickness skin grafts longitudinally on a vaginal stent that is molded into bullet shape. Six girls with vaginal agenesis underwent neovaginal construction using this method. The apex of the neovaginal cavity was perfectly epithelialized using this vaginal stent. The length of the neovaginal cavity that is dissected during the operation was protected. The follow-up period ranged from 24 to 93 months (median, 57.2 months). Postoperative stricture or contracture of the neovagina did not occur in all patients. As a result, full-thickness skin graft is an efficient method for vaginal construction in patients with vaginal agenesis.

Full-Thickness Skin Grafts for Neovaginal Construction in Mayer–Rokitansky–Küster–Hauser Syndrome

“…17 Of the cases of MRKH syndrome treated with FTSGs reported in the plastic surgery literature to date, no complication of vaginal stenosis has been described. [18][19][20] Although cases of vaginal stricture following FTSG vaginal reconstruction may be unreported to date, contracture is always a possibility following any grafting of the skin. However, the successful outcomes in the 5 patients described in this article are in accordance with the previously reported cases.…”

Total vaginal reconstruction with combined ‘Split Labia Minora Flaps’ and full‐thickness skin grafts

“…Bleeding after intercourse, lack of lubrication, dysparaeunia, stricture and foreshortening of the vaginal cavity are other pitfalls. FTSG, 22 buccal mucosa grafts 23 and amnion grafts 24 are also used in the epithelization of the neovaginal cavity. Less contraction and foreshortening compared to the STSG technique are reported but contraction, especially in the vaginal orifice, is of great concern 22 .…”

Use of infragluteal folds as a full‐thickness skin graft donor site for construction of the neovagina in cases of Mullerian agenesis

“…Physical examination invariably demonstrates a normally appearing external genitalia with a small vaginal dimple or complete vaginal agenesis. The development of pubertal activity and secondary sex characteristics are not impaired due to the presence of a normal hormone profile attributed to the presence of normally functioning ovaries …”

“…As a surgical alternative, split‐thickness skin graft (STSG) vaginoplasty has been widely performed since being described by Abbé and modified by McIndoe and Banister . However, it has the disadvantages of stenosis or foreshortening of the neovagina due to a marked tendency of STSG to contract . Furthermore, the donor site of an STSG can be a significant source of patient discomfort, and in some cases, hyperpigmentation and marked scarring can be observed .…”

“…When compared with STSGs, full‐thickness skin grafts (FTSGs) seem to be more suitable for lining the created neovaginal pouch, resulting in a lesser degree of contraction due to their higher content of dermal elastin and lower donor site morbidity due to the capacity of primary closure . As is the case in routine reconstructive surgery practice, the groin is the most preferred donor site in FTSG vaginoplasty because this area allows for a long and wide FTSG to be harvested.…”