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    Vaginoplasty and the role of autologous buccal mucosa

    Buccal mucosa is an ‘excellent graft alternative’ for simple and complex repairs

     

    Preoperative surgical considerations

    Given there are many anatomic variants in need of vaginoplasty, many vaginoplasty techniques have been described. In order to guide technique choice, several preoperative surgical questions should be answered:

    Is the vaginoplasty a primary procedure (no prior vaginal or perineal operation) or a secondary procedure (vaginal or perineal reoperation) fraught with extensive scarring?

    Is the quantity and quality of native vaginal tissue available for use in the vaginoplasty sufficient to correct the anomaly?

    Where is the healthy native vaginal tissue located (if any is present)?

    Figure 2. Urogenital sinus anomalies can exist with or without external genital ambiguity and consist of internal fusion of the vagina and urethra. Here is a case of congenital adrenal hyperplasia demonstrating ambiguous external genitalia (clitoromegaly), a urogenital sinus, and normal anorectum. (Photo courtesy of Linda A. Baker, MD)

    Figure 2. Urogenital sinus anomalies can exist with or without external genital ambiguity and consist of internal fusion of the vagina and urethra. Here is a case of congenital adrenal hyperplasia demonstrating ambiguous external genitalia (clitoromegaly), a urogenital sinus, and normal anorectum. (Photo courtesy of Linda A. Baker, MD)

    If the available native vaginal tissue is totally sufficient for vaginal reconstruction and the vaginal introitus is stenotic, then perhaps a simple pulldown procedure with scar excision could be performed. However, if there is some usable native tissue available but the amount is insufficient for reconstruction, a composite vaginoplasty must be performed. A composite vaginoplasty would consist of native vaginal tissue augmented by neovaginal tissue taken from a donor site.

    Read: Pediatric urolithiasis: Update and practical pointers

    Lastly, if there is a complete absence of the vagina, a total neovagina must be constructed from donor tissue. If neovaginal tissue is needed, then a decision for the surgeon is the choice of the best donor tissue source.

    Next: Neovaginoplasty options and concerns

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