Vaginal Wall Defects Research Articles

Novel Vaginal Cerclage Assisted Laparoscopic Cervico-Sacropexy Technique for Uterovaginal Prolapse.

Laparoscopic hysteropexy is a complicated procedure that requires specialized surgical skills, including precise dissection and suturing. The aim is to describe the technical considerations for performing a new, feasible, and minimally invasive technique to correct apical and concurrent apical and anterior vaginal wall defects. A retrospective analysis was conducted on 70 consecutive women who underwent surgery for stage ≥3 uterovaginal prolapse. As a part of the technique, an anterior 2-cm long transverse incision was made at the anterior cervicovaginal junction, and the bladder was dissected through blunt and sharp dissection to the level of the isthmus. A posterior colpotomy was performed. A polypropylene tape was inserted into the cervical connective tissue, and the free arms of the tape were inserted into the peritoneum via the posterior colpotomy. Two arms of the tape were passed from the tunnel parallel and medial to a right sacrouterine fold, then fixed to the anterior longitudinal ligament via the laparoscopic route. The tape can be inserted into the cervix in a median of 15min, and the laparoscopy procedure can be completed in 24min. No mesh erosion or long-term complications occurred. At a 1-year control, there were no cases of recurrence. This novel cervico-sacrocolpopexy technique is a feasible and safe, minimally invasive way to correct apical or multicompartment defects, with a short operation time and an anatomical result that mimics the normal sacrouterine ligament.

Introducing an innovative surgical technique: gluteal turnover flap for posterior vaginal wall reconstruction: a case series

Four patients with rectal cancer required reconstruction of a defect of the posterior vaginal wall. All patients received neoadjuvant (chemo)radiotherapy, followed by an en bloc (abdomino)perineal resection of the rectum and posterior vaginal wall. The extent of the vaginal defect necessitated closure using a tissue flap with skin island. The gluteal turnover flap was used for this purpose as an alternative to conventional more invasive myocutaneous flaps (gracilis, gluteus, or rectus abdominis). The gluteal turnover flap was created through a curved incision at a maximum width of 2.5 cm from the edge of the perineal wound, thereby creating a half-moon shape skin island. The subcutaneous fat was dissected toward the gluteal muscle, and the gluteal fascia was incised. Thereafter, the flap was rotated into the defect and the skin island was sutured into the vaginal wall defect. The contralateral subcutaneous fat was mobilized for perineal closure in the midline, after which no donor site was visible.The duration of surgery varied from 77 to 392 min, and the hospital stay ranged between 3 and 16 days. A perineal wound dehiscence occurred in two patients, requiring an additional VY gluteal plasty in one patient. Complete vaginal and perineal wound healing was achieved in all patients. The gluteal turnover flap is a promising least invasive technique to reconstruct posterior vaginal wall defects after abdominoperineal resection for rectal cancer.

Detrusor underactivity in symptomatic anterior pelvic organ prolapse.

The aim of this study was to assess the detrusor underactivity (DUA) prevalence of females with symptomatic anterior pelvic organ prolapse (POP) and to evaluate the relationship between DUA and POP stage. This was a prospective study recruiting women with symptomatic anterior POP. Patients with symptomatic stage 2-4 POP quantification system (POP-Q) who underwent urodynamics (UD) between January 2018 and April 2021 were included. Data on 330 women (mean age 63.7 ±18.4 years old) with anterior vaginal wall defect were enrolled. Concomitant apical defect (uterine/vaginal vault) requiring surgical correction was diagnosed in 38 women (11.5%). DUA was found in 166 females (50.3%). In DUA women, POP-Q stage 2 was found in 45.2%, stage 3 in 50.9% and stage 4 in 76.5%. Only stage POP-Q stage 4 showed a statistically significant difference between DUA and non-DUA females (p 0.006). In women with symptomatic POP, regardless of the POP-Q stage, the chance of DUA occurrence was high. DUA was diagnosed in approximately half of the women undergoing UD for symptomatic POP, and it was three-fold higher in cases of POP-Q stage 4. Due to the high incidence of DUA in POP-Q 4 stage, it may be advantageous to identify and treat prolapse before they progress to stage 4.

Incidence and Study of Sociodemographic Factors & Other Risk Factor fors Pelvic Organ Prolapse

Backgound: The burden of pelvic organ prolapse in parous women is enormous. Bangladeshi women suffers a lot due to (POP) pelvic organ prolapse. Minor prolapse or laxity is generally ignored. When serious functional disability develops, women seek treatment advice. Home delivary and subinvolutions during puerperium is thought to predispose to urogenital prolapse. Here the incidence of different degree of prolapse and associated risk factors are assessed. Materials and method; This prospective observational study was carried out in outpatient department of gynaecology and obstetrics of SSMCMH during the period of January 2018 to September 2018. 100 parous women with subjective symptom of prolapse were included. Degree of prolapse and related risk factors were identified. Results: Here 53% had Pelvic Organ Prolapse Quantification System (POP-Q) grade 1,32% had grade II and 15% had grade III and IV. Majority showed anterior vaginal wall defect. Cystocoele was 77% and perineal tear was 79%. Rectocoele was also present in 60% cases. Risk increases with increasing age 45% was >60 years. Multipara (>4 child) had the highest incidence. Also H/O home delivery, delivery by untrained personal, puerperial unusual work load increases the risk. Conclusion : POP is a common condition. Here the prevalence of grade I and II were high. But grade III and IV requiring surgical treatment among the women was 12% and 3% respectively .Incidence rises with increasing age, parity, prolonged and difficult labour . Birth spacing <2 years and neglected puerperial period also contribute. Sir Salimullah Med Coll J 2022; 30: 129-132

Cog Threads for Transvaginal Prolapse Repair: Ex-Vivo Studies of a Novel Concept

The diagnosis and treatment of pelvic organ prolapse (POP) remain a relevant and scientifically challenging topic. The number of cases of genital prolapse increases each year, one in ten women need at least one surgical procedure and one in four women in midlife have asymptomatic prolapse. Using mesh implants to correct POP presents unsatisfactory clinical outcomes, requiring hospital readmission and further surgery. We hypothesize using an alternative surgical intervention technique, applying injectable biodegradable cog threads, currently used for face lifting procedures, to reinforce and correct vaginal wall defects. The threads used in this investigation are commercially available 360° 4D barb threads (PCL-19G-100), made of polycaprolactone (PCL), supplied in sterile packs (Yastrid, Shanghai, China). Eleven sows’ vaginal walls were used to analyze the immediate reinforcement effect of the threads. Uniaxial tensile testing and scanning electron microscopy (SEM) was performed for the initial characterization of the threads. Threads were inserted into the vaginal wall (control n = 5, cog n = 5) and were characterized by ball burst testing; a pull-out test was performed (n = 6). With SEM images, dimensions, such as thread diameter (≈630 µm), cut angle (≈135°), cut depth (≈200 µm) and cog distance (≈1600 µm) were measured. The mechanical behavior during uniaxial tensile testing was nonlinear. Threads could sustain 17–18 N at 18–22% of deformation. During the ball burst test, vaginal tissue reinforced with threads could support 68 N more load than normal tissue (p < 0.05), indicating its strengthening effect. Comfort and stress zones were significantly stiffer in the tissues reinforced with threads (p < 0.05; p < 0.05). Both groups showed identical deformation (elongation); no significant differences in the comfort zone length were observed, showing that threads do not affect tissue compliance. The pull-out test showed that the threads could sustain 3.827 ± 0.1891 N force when the first cog slip occurs, at 11.93 ± 0.8291 mm. This preliminary research on using PCL cog threads for POP treatment showed promising results in increased vaginal wall resistance to pressure load and, at the same time, not affecting its compliance. Nevertheless, to obtain long term host response in vivo, further investigation will be carried out.

The role of hydrodissection in native tissue repair of anterior vaginal wall defects

A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ2 and Fisher's exact tests. Forty-six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). After hydrodissection, less bleeding was noted without compromise the surgical planes.

Five-year outcomes of an anterior mesh kit for severe pelvic organ prolapse in women.

The Elevate™ Anterior mesh was designed to correct anterior vaginal wall defects by providing level 1 and 2 support via a single incision and transvaginal approach. This study aimed to examine the objective and subjective outcomes following prolapse repair using the Elevate™ Anterior mesh kit. A retrospective case series review of 270 patients with Baden-Walker Grades 3 or 4 anterior compartment prolapse who underwent the Elevate™ Anterior mesh kit was undertaken. Operative complications were recorded with follow-up intervals arranged at 1, 6, 12, 24, 36, 48 and 60 months. A standardized questionnaire directed at urinary, pain and recurrence symptoms was used at each follow-up visit. Pelvic examinations were performed at each follow-up visit to assess for objective cure and for detection of complications. The primary outcome was to assess the cure rate defined as anterior vaginal wall prolapse ≤ Grade 1. The follow-up rate was 28.9%. Subjective and objective cure rates at 60 months were 100% and 96.2%, respectively. Ten (3.7%) intraoperative complications were recorded. At 60 months, three (3.8%) patients complained of de novo stress/urge urinary incontinence. One patient had dyspareunia at 6 months postsurgery which resolved by the end of 1 year. Prolapse recurrences in the anterior compartment was 3.8% at the end of 5 years. Mesh exposure into the vagina occurred in three patients. In conclusion, our experience with the Elevate™ Anterior mesh kit had promising subjective and objective outcomes with high patient satisfaction rates.

Wound dehiscence prevalence and relationship with prosthetic material extrusion in women underwent anterior colpotomy.

Aim:To assess the prevalence of anterior vaginal wall dehiscence in women who underwent anterior vaginal wall colpotomy for pelvic organ prolapse or stress urinary incontinence and to evaluate the influence of suture materials and techniques on wound dehiscence.Materials and Methods:This multicenter, prospective study enrolled naïve women for urogynecological surgery affected by anterior vaginal wall defect or stress urinary incontinence. Performed surgical procedures were anterior vaginal wall repair (AVWR) with native tissue (N-AVWR) or polypropylene mesh (M-AVWR), trans-obturator polypropylene in-out middle urethral sling (MUS). Used suture materials were Vicryl 2-0, Vicryl Rapide 2-0, and Monocryl 3-0. Suture techniques were running interlocking or interrupted. Follow-up was performed daily during hospitalization and in outpatient clinic after 10–14, 30 days, and after 3 months.Results:A total of 1139 patients were enrolled. AVWR were 790: 89.1% N-AVWR, and 10.9% M-AVWR. Polypropylene MUS were 349. Women with prosthetic implantation were 38.2%, while 61.8% had native tissue repair. Overall Vicryl was used in 53.9%, Vicryl Rapide in 37.4%, and Monocryl in 8.7%. Overall running interlocking sutures were 66.5%, while interrupted were 33.5%. Overall wound dehiscence prevalence was 0.9% (10/1139). Wound dehiscence rate of 0.6% (5/790) was documented in AVWR: 0.3% (2/704) in N-AVWR, and 3.5% (3/86) in M-AVWR. Among women underwent MUS, 1.4% (5/349) showed wound dehiscence. In patients who underwent prosthetic surgery, the overall dehiscence prevalence was 1.8% (8/435). A statistically significant higher rate of wound dehiscence was found in women with implanted prosthetic materials.Discussion:We reported for the first time the prevalence of wound dehiscence in females who underwent colpotomy for AVWR or MUS. Wound dehiscence occurrence was low, but non-negligible. We found that this complication was poorly associated to the suture methods and materials, while prosthetic material represented a risk factor for wound healing.

Anterior Vaginal Wall Prolapse Repair and the Rise and Fall of Transvaginal Mesh. Did We Come Full Circle? A Historical Perspective

ObjectiveTo present a brief historical review of treatment options for pelvic organ prolapse with a focus on anterior vaginal wall defects and highlight changing practice patterns in the era of synthetic mesh controversy. MethodsA MEDLINE and PubMed search was performed using the keywords pelvic organ prolapse, anterior colporrhaphy, and cystocele followed by a manual search of bibliographies. ResultsAncient treatments included Hippocratic succession, local astringent, and use of pomegranates as crude pessaries. More sophisticated surgical techniques evolved in the 19th century with further refinement in the early 20th century. Numerous native tissue apposition techniques were popularized by Kelly, Kennedy, Burch, and Raz. Due to poor durability, surgeons sought alternate approaches including biologic and synthetic grafts. Synthetic transvaginal mesh (TVM) initially included use of Tantalum and Marlex to repair anterior wall defects. Both were eventually abandoned due to complications. TVM was re-designed, re-marketed, and re-introduced. Type 1 polypropylene monofilament TVM use became ubiquitous in female pelvic surgery peaking between 2004 and 2008. Initial promising outcomes were soon eclipsed by a surge of adverse events leading to multiple FDA warnings, reclassification to Class III, high-risk medical device, and ultimately a complete recall in 2019. ConclusionThe bidirectional pendulum swing on use of synthetic TVM has been occurring since its introduction 50 years ago. In the current era of mesh controversy, more practitioners are now revisiting previously described native tissue and biologic graft techniques. It appears that history has repeated itself.

A Prospective Comparative Study of the Feasibility and Reliability of Telephone Follow-Up in Female Urology: The Patient Home Office Novel Evaluation (PHONE) Study

ObjectiveTo determinate the feasibility, reliability, and patient satisfaction of telephonic follow-up in women treated for stress urinary incontinence (SUI) or pelvic organ prolapse (POP): Patient-Home-Office-Novel-Evaluation (PHONE) study. MethodsThis is a prospective comparative study in women following surgery for SUI underwent middle urethral sling (MUS) (Group A), or symptomatic anterior vaginal wall (AVW) defect underwent AVW repair (fascial/mesh/biomesh) (Group B). The 1-year follow-up included a telephonic interview using a checklist and validated questionnaires followed by a standard outpatient clinic visit 7-12 days later including: an interview, validated questionnaires, objective examination, and score satisfaction with the telephone follow-up. ResultsWe enrolled 420 pts: 215 for SUI in Group A, and 205 for POP in Group B. SUI recurrence was 19.1% and 11.6% at the telephone and office follow-up, respectively. De-novo urgency urinary incontinence rate was 7.5%. Telephone follow-up was able to detect POP recurrence and related symptoms. Tape and mesh extrusions were detected only at the objective evaluation: 1.9% and 4.4% respectively. No difference was found at the questionnaires. Satisfaction with the telephone follow-up was high. ConclusionDue to the wrongly interpretation of de-novo urge urinary incontinence as a recurrence of SUI, a telephone interview may lose reliability in case of reported incontinence. Thus, telephone follow-up was feasible and reliable in women not reporting incontinence. In patients treated for POP the phone interview was a valid tool only in case of no-prosthetic surgery due to the absence of extrusion in these cases.

Assessment of Overactive Bladder after Laparoscopic Lateral Suspension for Pelvic Organ Prolapse.

Background Pelvic organ prolapses (POP) and overactive bladder (OAB) may coexist and both negatively impact quality of life in women. The correlation between POP and OAB remains unclear, but these patients may have the OAB resolution after the surgical treatment of POP. Aim of our study was to assess the anatomical results and the effect on OAB symptoms in women who underwent laparoscopic lateral suspension for POP. Materials and Methods This prospective study included all women with apical POP who underwent surgical repair with laparoscopic uterine lateral suspension from January 2016 to December 2017. The baseline and the 1-year follow-up included post-void residual measurement, urinalysis, vaginal examination, OAB symptoms evaluation, and administration of questionnaires (PFDI-20, UDI 6). Results 64 women underwent laparoscopic lateral suspension for uterine prolapse and 78.1% had concomitant anterior vaginal wall defect. At 1-year follow-up the anatomic success rates were 84.4% for the apical and 76.2% for the anterior compartment. The comparison between OAB symptoms before and after the surgical procedure showed the resolution of OAB in 76% of the women, while de novo OAB was present in 2.6%. With the questionnaires 95.3% (61/64) of our patients were satisfied after the POP repair. We documented a trend in ameliorating of OAB regardless of the POP-Q stage. However, the Pearson test showed this correlation as statistically significant only in women with anterior vaginal wall defect stage III and apical stage II. No patient had vaginal exposure of the polypropylene mesh. Conclusion Our data show how laparoscopic lateral suspension is an effective procedure for apical and anterior vaginal wall defects. This study provides further evidence for the concept that OAB in women with POP >II stage improves after a successful POP surgery. These women may benefit from a resolution of OAB and POP symptoms with the improvement of patient's quality of life.

Modern indications of synthetic mesh in surgical treatment of pelvic organ prolapse

Background . The treatment of genital prolapse is exclu­sively surgical, usually approached from the perineal area. If surgery is not recommended, the solution can be conservative palliative. Method . This paper is based on scholarly medical articles and the expertise of Bucur Clinic of Obsetrics and Gynecology, between January 2010 and December 2016, in relation with modern surgical treatments of genital prolapse, using synthetic mesh. Results . Between January 2010 and December 2017, at the Bucur Clinic of Obstetrics and Ginecology, there were 320 patients surgically treated for urogenital affections. There were registered 53 cases of first- and second-degree genital prolaps, and 65 cases of third-degree genital prolaps. A num­ber of 98 patients presented cystorectocele, of which 82 associated with stress urinary incontinence and only 40 with uterine prolaps. There were made 67 direct cystopexies with polypropylene allograft by the transobturator mid­urethral slings procedure (TOT). Also, the Kelly technique was systematically applied for the surgical management of stress urinary incontinence (SUI). The isolated SUI cases have been treated by the aplications of a suburethral sling, again using the TOT technique(61). The surgical treatment for posterior vaginal wall defect usually consisted in posterior colporrhaphy with perineorrhaphy(73). In cases associated with important uterine descensus, the standard technique consisted in hysterosacropexy with or without reinforcement of the rectovaginal fascia with synthetic mesh (3/14). A total of 7 colpocleisis have been recorded exclusively in elderly patients with associated biological conditions, for which extensive surgery was not recommended. Discussion . Petros and Ulmstem’s integral theory, which was developed in the ’90s, states that pelvic-genital static disorders and those of urinary incontinence come from the alteration of fascial and ligamentary structures that are part of the pelvian diaphragm. This theory led to the development of vaginal and endoscopic surgical tehniques using syntetic allograft. After a period of prolonged use because of its superior efficiency on a long term, the indications of synthetic allografts have been reduced and they are reserved now for patients with large defects of pelvine statics, for recurrent cases or for women in perimenopause. An important criterion in the surgical choise is the conservation of sexual function. Conclusions . It is recommended to use the surgical correction of prolapse using synthetic mesh only in case of failure of a first surgery, or if there are known risk factors for the recurrence of prolapse.

Laser treatment for stress urinary incontinence

Stress urinary incontinence (SUI) is defined as involuntary leakage of urine with increased intra-abdominal pressure. SUI is due to the progressive herniation of bladder, bladder neck and urethra from the anterior vaginal wall defect. Main defect in the anterior vagina is due to deficient collagen content of the endopelvic fascia.

Flap design and perfusion are keys ofsuccess: Axial fasciocutaneous posterior thigh flaps for deep small pelvic defect reconstruction.

Radical excisions of the rectum often result in large perineal and intrapelvic defects. Compromised wound healing can delay adjuvant therapies and limit the patient's prognosis. With current treatment, integrity of the abdominal wall may be maintained. The defect geometry is unique and requires extensive volume for reconstruction. This study describes the surgical technique and reports clinical outcomes of fasciocutaneous posterior thigh flaps as preliminary data for this indication. Thirteen posterior thigh flaps were used in eleven patients between 2013-2015. Patients were prospectively followed-up for the pursposes of this case series. Flap dimensions and volume were measured in two representative cases. The surgical technique is described in detail. Dead space occlusion was achieved in 100% of cases. No intestinal herniation was detected. Vaginal wall defects were concurrently reconstructed in two patients. Total flap volume was calculated as 315-360 cm3. The fasciocutaneous flaps were easy to harvest, versatile to manipulate and did not result in significant function deficits. In contrast to classic Vertical Rectus Abdominis Muscle (VRAM) flaps, the posterior thigh flaps preserve abdominal wall function and should be considered as a reliable alternative option in reconstruction of intrapelvic defects including neighboring organs. Future studies of larger patient series should be executed to verify our findings and determine the optimal point in time for reconstruction.

69: Dynamic MRI for the detection of posterior vaginal wall defects and its association with clinical in-office exam versus intraoperative exam under anesthesia

69: Dynamic MRI for the detection of posterior vaginal wall defects and its association with clinical in-office exam versus intraoperative exam under anesthesia

53: Prevalence of defecatory symptoms in patients with posterior vaginal wall defects on dynamic MRI

53: Prevalence of defecatory symptoms in patients with posterior vaginal wall defects on dynamic MRI

Intravesical mini-laparoscopic repair of vesicovaginal fistulas

Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary result of gynecological surgery. Some minimally invasive techniques have been introduced to decrease the morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical mini-laparoscopic approach. The aim of this study was to present our initial clinical experience using this technique for transvesical VVF repair. In 2013 and 2014, we carried out mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3-mm instrument and a 5-mm, 30° scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separated continuous barbed, resorbable 3-0 sutures (V-Loc 90 Absorbable Wound Closure Device; Covidien, Norwalk, CT, USA). The median operative time for the two patients was approximately 100 min, and the blood loss was not clinically significant. The patients were released from the hospital 24 h after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive, easily reproducible approach with few associated complications. Nevertheless, further experience and observations are necessary.

Vaginal Wall Repair – Using Amniotic Membrane Graft

Background: Standard colporraphy has been the main surgical procedure for vaginal wall prolapse for many years, with disappointing cure rates. Many investigators are now searching for alternative surgical techniques and materials to achieve better long term, postoperative results. Amniotic membrane is a natural human membrane tissue; when used as a vaginal graft, it will attract collagen, fibrinogen, and integrate with the local fascia providing a tough sheath, necessary for support and augmentation of the weak local fascia, to support the bladder, rectum, and vagina. It has been proven to demonstrate low antigenicity (incomplete HLA-A, B, C, and DR antigens), and hence will not be rejected by the recipient. Objective: To test the clinical and surgical applicability of using a biological fresh amniotic membrane graft for the trans-vaginal repair of site-specific defects in anterior and posterior vaginal wall prolapse. Method: A trapezoid shaped amniotic membrane graft (8 X12 cm) was applied to the anterior vaginal wall to correct the site-specific defect, by anchoring the graft to the Arcus Tendineous Fascia Pelvis, latterly at four points. While a superficial amniotic membrane graft (8 X 4cm) was placed on the posterior vaginal wall, between the rectum and the vagina, to correct the posterior wall defect. Excess graft material was excised. 21 patients had this procedure till now. All had spinal anesthesia, *3 had it with a vaginal hysterectomy, *6 had it with an anterior & posterior vaginal repair, *12 had it with a posterior vaginal repair. Results: Patients with grade II or III vaginal defects were included in this study i. *Average age was 44.6 years. ii. *Average parity was 4.2. iii. *80% of patients had no complications, 20% had minor complications, relieved by medication. iv. *No serious infections, rejections, and complications were noted till now (Max. period of study-180 days) v. *3 had mild de novo urgency. vi. *1 had delayed vaginal healing. Conclusion: In our study amniotic membrane graft was used for treating vaginal wall defects successfully with no serious complications. We feel that more studies are needed to better evaluate the efficacy and safety of this new surgical technique for vaginal wall repairs.

Perineal and posterior vaginal wall reconstruction with a superior gluteal artery dual perforator-pedicled propeller flap.

Gluteal artery perforator flaps are a good option to reconstruct perineal and posterior vaginal wall defects after abdominoperineal resection. The bulkiness of the folded flap may compromise the results by obliterating the introitus and vaginal cavity. In this report, we present a case of the use of a superior gluteal artery dual perforator-pedicled propeller flap to reconstruct the posterior vaginal wall and perineum in a 60-year-old female who had an abdominoperineal resection of a locally progressive anal squamous cell carcinoma. Two perforators were completely skeletonized through gluteus maximus muscle fibers. The vascularization of the skin flap was based on the first perforator, whereas the aponeurotic flap was vascularized by the second perforator. The vaginal defect was reconstructed with a gluteus maximus aponeurotic flap, and the perineal reconstruction was based on a superior gluteal artery perforator skin flap. No postoperative infection or necrosis occurred. Skin healing was completed in 3 weeks. Vaginal opening was controlled using lubricant and graduated vaginal dilators during 6 weeks. The patient began sexual intercourse 2 months postoperatively. No revision was needed. Perineal and posterior vaginal wall defects may be reconstructed with a gluteal artery perforator flap. The thickness of the flap allows a complete filling of the full perineal cavity. The gluteus maximus aponeurosis may be suitable for the reconstruction of the posterior vaginal wall.

A New Reconstructive Technique for Posterior Vaginal Wall Defects, a Case Report

Post-partum vaginal laxity is a problem encountered by many women. More uncommon is a resulting vaginal defect. In most cases of laxity, a period of extensive physiotherapy can strengthen the pelvic muscles enough for symptoms to be minimized. However, this is not the case once there is a tissue defect. To present a new reconstructive method for patients with posterior vaginal wall defects. We present a case of a 38-year-old female who, 12 years prior to presentation, had a vaginal delivery. Due to complications during the delivery, she sustained pelvic trauma and developed a posterior vaginal wall defect. She had a sizable soft tissue defect, causing sexual, urinary, and confidence problems. Fat was harvested from the patient's abdomen and injected into the defect after more conservative treatment options were exhausted. The defect was corrected successfully using the minimally invasive Coleman fat grafting technique. This is to our knowledge the first case in the literature where a posterior vaginal defect has been corrected using Coleman fat grafting, and we believe that this treatment method may be of benefit to more patients.