PMC5404652_01
Findings before the operation no pubic hair was observed and the vagina measured 3 cm. The vaginal vestibule narrowed on the anal side.
icrp_a_1296363_f0001_c.jpg
PMC5404652_01_icrp_a_1296363_f0001_c.jpg
F0001
The vagina measured 3 cm and there was a coecum, while the vaginal vestibule narrowed on the anal side (Figure 1).
Findings of transvaginal ultrasonography the uterus was absent and the distance from the tip of the vaginal caecum to the retroperitoneum was 2.7 cm.
icrp_a_1296363_f0002_c.jpg
PMC5404652_01_icrp_a_1296363_f0002_c.jpg
F0002
Design of PTF the bilateral skin flaps were extended towards the anal side, thereby reconstructing the vaginal vestibule using these parts.
icrp_a_1296363_f0003_c.jpg
PMC5404652_01_icrp_a_1296363_f0003_c.jpg
F0003
Moreover, the bilateral skin flaps were extended towards the anal side, thereby reconstructing the vaginal vestibule using these parts (Figure 3).
Harvesting PTF.
icrp_a_1296363_f0004_c.jpg
PMC5404652_01_icrp_a_1296363_f0004_c.jpg
F0004
The bilateral PTFs were elevated under the fascia (Figure 4), a tunnel was made underneath the skin of the outer labia, and subsequently, these skin flaps were moved to the centre (Figure 5).
Moving PTF to the centre.
icrp_a_1296363_f0005_c.jpg
PMC5404652_01_icrp_a_1296363_f0005_c.jpg
F0005
The bilateral PTFs were elevated under the fascia (Figure 4), a tunnel was made underneath the skin of the outer labia, and subsequently, these skin flaps were moved to the centre (Figure 5).
Creating an intravaginal cavity.
icrp_a_1296363_f0006_c.jpg
PMC5404652_01_icrp_a_1296363_f0006_c.jpg
F0006
Next, the skin flaps were sutured together from the distal part of the skin flap in the shape of a lumen, thereby creating an intravaginal cavity (Figure 6).
Post operation (a) a vertical incision was made in the narrowed vaginal vestibule of the anal side and part of the anal side of PTF was inserted. (b) The donor site was temporarily reefed along the contour line of the inner proximal region of the thigh.
icrp_a_1296363_f0007_c.jpg
PMC5404652_01_icrp_a_1296363_f0007_c.jpg
F0007
Moreover, in order to make the vaginal vestibule, a vertical incision was made in the narrowed vaginal vestibule of the anal side along with the remaining vaginal mucous membrane and subsequently, part of the anal side of the skin flap was inserted (Figure 7(a)). The donor site was temporarily reefed along the contour line of the inner proximal region of the thigh (Figure 7(b)).
(a) Two years and four months following surgery. No stenosis of the vaginal vestibule or opening of the vagina was observed. (b) Two years and four months following surgery. No stenosis of the vaginal vestibule or opening of the vagina was observed.
icrp_a_1296363_f0008_c.jpg
PMC5404652_01_icrp_a_1296363_f0008_c.jpg
F0008
No stenosis of the vaginal vestibule or opening of the vagina was observed (Figure 8(a)) and a substantially satisfactory vulva shape was thereby acquired (Figure 8(b)).