Abstract
Abstract Background: Mayer–Rokitansky–Kuster–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 unde...
Highlights
Realdus Columbus (1516–1559 ad) first described congenital absence of the vagina in 1572.1 The German anatomist and physiologist, August Franz Joseph Karl Mayer (1787–1865 ad), reported the congenital absence of the vagina as one of the abnormalities found in stillborn infants with multiple birth defects.[2]
The French military surgeon Guillome Dupuytren, MD (1777–1835 ad), gained much esteem for treating Napoleon Bonaparte’s hemorrhoids, Dupuytren is often credited with the first attempt at vaginoplasty in 1817.15 The use of a split-thickness skin graft to line the cavity dissected between the bladder and the rectum was first pioneered by the world-renowned American surgeon Robert Abbe, MD (1851– 1928).[11]
Sadove and Horton were the first researchers to discuss the application of full-thickness skin grafts (FTSGs) for vaginal reconstruction in 1988.17 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]
Summary
Realdus Columbus (1516–1559 ad) first described congenital absence of the vagina in 1572.1 The German anatomist and physiologist, August Franz Joseph Karl Mayer (1787–1865 ad), reported the congenital absence of the vagina as one of the abnormalities found in stillborn infants with multiple birth defects.[2]. Patient #1 was a 23-year-old woman who experienced 100% graft take following FTSG reconstruction after 6 months of continuous dilator usage. Patient #4 was a 22-year-old woman who underwent neovagina reconstructive surgery using FTSGs at age 22 Because of her smaller anatomical dimensions, the planned dissection of the vesicorectal space was not possible, and a smaller temporary dilator had to be fashioned intraoperatively following stent removal, until which time a permanent dilator could be procured. On her last examination this patient had a neovagina of functional dimensions with no stenosis or contracture. She has not yet had vaginal intercourse as of this writing
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