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

Abstract

Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by vaginal agenesis, the treatment of which typically involves neovaginal construction using split-thickness skin grafts. While successful in many patients, this method may result in vaginal contracture or foreshortening. Neovaginal construction using full-thickness skin grafts (FTSGs) is an underutilized surgical technique associated with decreased rate of contracture and improved functional outcomes. Cases: FTSGs were used for neovaginal construction in 5 patients with MRKH syndrome. This report describes the surgical technique and the current authors' experience when using it. There was a mean follow-up time of 39.4 months (range: 9-111 months). Results: All 5 grafts have remained patent, and all of the patients who desired vaginal intercourse are now capable of achieving this. None of the 5 patients had vaginal contraction or foreshortening. Conclusions: Neovaginal construction using FTSGs is an underutilized and underreported technique in the gynecologic literature. Surgical planning, dilator use, and management of granulation tissue are important considerations when applying this technique. In the current authors' experience, the use of FTSGs in neovaginal construction for patients with MRKH has been successful, with no incidence of vaginal contraction or foreshortening. ( J GYNECOL SURG 31:52)

Mayer–Rokitansky–Küster–Hauser syndrome managed with McIndoe’s vaginoplasty: a case series and literature review

“…Full-thickness skin graft (FTSG) can also be used to create neovagina in MRKHS as there is less incidence of vaginal contraction or foreshortening. However, there is a high risk of developing granulation in the donor graft and chances of development of ischaemia and necrosis in the donor area 12 .…”

Philip John DiSaia, MD: Available Light & The Origin of Storms

“…16 During this period he had also turned his attention to developing novel therapeutics for advanced ovarian carcinoma 17 clarifying the role of radiation therapy for endometrial cancer, 18 and using full-thickness skin grafts (rather than split-thickness) with the McIndoe neovagina procedure for young women with vaginal agenesis due to Mayer-Rokitansky-Kuster-Hauser syndrome. 19 Clinical Gynecologic Oncology (coauthored/edited with William T. Creasman) had emerged as the most highly regarded textbook in the subspecialty and a commitment from the publisher to issue a new edition on a five-to-six-year timetable. The Philip J. DiSaia, MD Society was established by former Residents in 1989, and the first President of the Society was Jim DeSoto.…”

“…He was leading important work to evaluate the safety and impact on the quality of life of estrogen replacement therapy among breast cancer and endometrial cancer survivors, and studying the tolerability to mother and fetus of neoadjuvant chemotherapy during pregnancy complicated by locally advanced cervical cancer . During this period he had also turned his attention to developing novel therapeutics for advanced ovarian carcinoma clarifying the role of radiation therapy for endometrial cancer, and using full‐thickness skin grafts (rather than split‐thickness) with the McIndoe neovagina procedure for young women with vaginal agenesis due to Mayer‐Rokitansky‐Kuster‐Hauser syndrome . Clinical Gynecologic Oncology (co‐authored/edited with William T. Creasman) had emerged as the most highly regarded textbook in the subspecialty and a commitment from the publisher to issue a new edition on a five‐to‐six‐year timetable.…”