The Use of Acellular Dermal Allograft for Vulvovaginal Reconstruction
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Abstract:
Many different techniques that require the surgeon to harvest autologous tissue to create a neovagina have been described in the literature.We describe a technique for creating a neovagina with the use of an acellular dermal allograft as a replacement for split-thickness skin graft. Three patients are presented who had a successful creation of a neovagina with this technique. The indications for vaginoplasty include vaginal agglutination from lichen planus, squamous cell carcinoma of the vagina, and vaginal agenesis.The creation of a neovagina using an acellular dermal allograft can be successfully accomplished in patients undergoing constructive and exenterative procedures. The use of an acellular dermal allograft decreases operative time and decreases the incidence of postoperative morbidity because harvesting autologous tissue for the neovagina is not required.Objective To study the effect of the use of peritoneum tor laparoscopic vaginoplasty in patients with congenital absence of vagina.Methods 9 patients with congenital absence of vagina were perfomed peritoneum for laparoscopic vaginoplasty from Oct ,2003 to Jan ,2009.Explore the pelvic by laparoscopic vaginoplasty,free the pelvic peritoneum,detach artificial vagina,pull the pelvic peritoneum from the artificial vagina,suture to form a vagina.Results The operation time was 120 ～ 170 minutes.Blood loss of operation was 50 ～200 ml.All patients had gas discharged 2 days after operation.Depth pf vagina made were 10 ～ 20 cm.3 years after operation,the vagina made all have a smoothy and tendy mucous membrane that their function or shape reached physiological goal Patients or their spouses were satisfied to their sex activity.Conclusion Use of peritoneum for laparoscopic vaginoplasty in patients with congenital absence of vagina has the advantages of short operation time,rapid recovery and no impact of physiological organ.Vagina membrane made by peritonem were smoothy and alike to normal vagina membrane.The use of peritoneum for laparoscopic vaginoplasty is an good operation way in patients with congenital absence of vagina.
Key words:
Congenital absence of vagina; Peritoneum; Laparoscopy
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Objective To study the curative effect of surgical treatment on congenital absence of vagina.Methods Clinical data about 25 patients with congenital absence of vagina admitted to our hospital from 2006 to 2011 were retrospectively analyzed.Of these patients,20 underwent vaginoplasty with acellulardermal repairing patch,3 underwent vaginoplasty with peritoneum,and 2 underwent vaginoplasty with amniotic membrane.Results The vagina mucosa was formed in 19 patients 8 weeks after vaginoplasty with acellulardermal repairing patch and in 1 patient after vaginoplasty with peritoneum.The satisfactory rate of the patients for sexual life was 90%.Conclusion The time of vagina mucosa formation is relative short after vaginoplasty with acellulardermal repairing patch.The satisfactory rate of vaginoplasty with acellulardermal repairing patch is high,and the procedure deserves to be recommended.
Sexual life
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To investigate the types, clinical features and therapeutic approaches of congenital anomalies of the vagina.The clinical data of 81 patients with congenital anomalies of the vagina were analyzed retrospectively.There were 5 types in these 81 patients, and 16 (19.7%) patients showed absence of the vagina, 15(18.5%) had vaginal obstruction, 10 (12.3%) had transverse vaginal septum,14(17.2%) had longitudinal vaginal septae,18(22.2%) had septum obliquus, and 8 (9.8%) had imperforate hymen. Forty-eight (59.2%) patients presented with primary amenorrhea, and 22(27.1%) complained of irregular pelvic pain. Fifteen of the patients with absent vagina underwent amnion artificial vaginoplasty, and the others were treated with incising and removing the septum, all having good clinical outcomes.Amnion artificial vaginoplasty is a good option for treatment of absent vagina.
Amnion
Vaginal disease
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Objective To investigate the possibility and efficacy of laparoscopic peritoneal vaginoplasty for the treatment of congenital absence of vagina. Methods A total of 4 patients with congenital absence of vagina underwent laparoscopic peritoneal vaginoplasty. Results Operations were performed successfully in the 4 cases. The mean operative time was 114 min (range: 90-160 min), and the mean postoperative hospital stay was 5.4 d (range: 5-6 d). There was no complication in all patients. Conclusion Laparoscopic peritoneal vaginoplasty is a safe, minimally invasive, and reliable method for the treatment of congenital absence of vagina.
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The objective of this case study is to present our experiences of a surgical innovative approach for vaginal agenesis using Interceed. The present report involved two subjects diagnosed to have vaginal agenesis due to Mayer-Rokitansky-Kiister-Hauser syndrome. Operation procedure involved the creation of a neovaginal tunnel and then a mold wrapped with Interceed was placed in the neovagina. The duration of surgery was around 30 min with minimal blood loss. Hospitalization stay was only 2 days after the procedure, with no operative and postoperative complications. Epithelialization of the neovagina was achieved within a month after surgery. The patients were satisfied with the outcome. The neovagina created with this procedure was the same with the normal adult vagina histologically and physiologically. In conclusion, the creation of a neovagina using Interceed resulted in favorable outcome and this approach may be a potential alternative to the management of vaginal agenesis.
Agenesis
Mayer-Rokitansky-Kuster-Hauser Syndrome
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[Objectives] To evaluate the functional outcomes and technical feasibility of laparoscopically sigmoid colon vaginoplasty in women with congenital absence of vagina.[Methods] Clinical data of eleven women with congenital absence of vagina treated by laparoscopically sigmoid colon vaginoplasty were retrospectively analyzed.A record was made of operating time,bleeding volume,postoperative complications,anatomical and functional outcomes of artificial vagina.[Results] The mean operating time was 143.7 min and the mean bleeding volume was 123.7 mL.There were no significant postoperative complications and all women and their partners were satisfied with the subsequent sexual activity.[Conclusions] Laparoscopically sigmoid colon vaginoplasty is a feasible,safe and effective approach for women with congenital absence of vagina.
Sigmoid function
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Objective To investigate the surgical treatment and therapeutic effect of laparoscopic peritoneal vaginoplasty on congenital absence of vagina.Methods The clinical data of 44 patients with congenital absence of vagina receiving laparoscopic peritoneal vaginoplasty were retrospectively analyzed.The operation time,blood loss volume and postoperative function of vagina were observed.Results Forty-three patients(97.7%)received successful operations.The operation lasted(63.40±13.98)minutes,and the blood loss volume was(74.25±17.75)mL.The time to passage of gas by anus was(2.40±0.89) days.All patients were followed up for(7.65±2.23)months.The length of vagina was(8.80±1.30)cm.Artificial vagina mucosa was smooth,ruddy and flexible,which was consistent with anatomical structures and could meet the physiological demand.Conclusion Laparoscopic peritoneal vaginoplasty is a safe,minimally invasive and reliable method for congenital absence of vagina.
Anus
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Objective To study the therapeutic effect of vaginoplasty using sigmoid colon graft for congenital absence of vagina. Method 12 cases of congenital absence of vagina were treated with vaginoplasty using sigmoid colon from May 2002 to August 2005. Results All cases were succeeded. The vagina could contain 2 fingers with a depth of 10 to 13 cm. 3 cases developed stricture 2 months postoperatively and improved by dilation. Within 6 months to 3 years follow-up, 11 cases had sex intercourse of which 10 cases were satisfied and 1 case was dissatisfied. Conlusion Vaginoplasty using sigmoid colon graft for congenital absence of vagina is effective, and dilation within 2 months postoperatively is recommendable to prevent stricture.
Sigmoid function
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Meatal stenosis
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Vaginal agenesis is a rare condition that can be treated successfully with a variety of nonoperative as well as surgical procedures. The difference between most of the surgical techniques lies in the material used to line the newly created canal. Skin grafts, peritoneum, and amnion have all been reported for this purpose. In the present study, four women with vaginal agenesis underwent surgical construction of an artificial vagina using Interceed Absorbable Adhesion Barrier to cover an inflatable stent placed within the neovagina. There were no intraoperative or postoperative complications, and epithelialization of the neovagina was complete by 3-6 months. All four subjects were satisfied with the results of the surgery and none of the women reported difficulty complying with postoperative care. This modification of the Abbe-McIndoe technique does not require a separate operative procedure to harvest a lining for the neovagina. The use of Interceed may reduce the cost, operative time, and morbidity associated with other vaginoplasty techniques.
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