PMC4771847_01
MRI T2WI in the sagittal plane after intravaginal gel administration depicts a lack of vaginal distention, and an abnormal homogenous diffuse high signal intensity in the vaginal walls, secondary to vaginal stenosis and fibrosis.
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After considering all findings and patients complaint, we decided to perform the reconstruction without visible scars around perineal and thighs (Fig. 1).
Flap molded as desired right after anastomosis to the deep inferior epigastric artery and vein and before insetting to reconstruct the new vagina.
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After transferring the segment to the pelvis, microsurgical anastomosis performed to the right inferior epigastric vessels and satisfactory flow was confirmed with an intraoperative Doppler (Fig. 2).
Schematic drawing of the flap inset. Notice the particular design of the flap which allowed us to reconstruct the posterior wall of the vagina and at the same time\r\nelongate it.
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Inferior part of the jejunum sutured to the remnant of the vagina without tension with 3.0 braided sutures and then, the posterior wall of the vagina was created with the flap (Fig. 3).
CT in the sagittal plane after administration of iodinated contrast medium in the neovagina shows the size, shape, location, and intestinal pattern of the walls, as well as the excellent distention. The study confirms the absence of contrast leaks in the stump.
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She was reviewed in the clinic 2 months postoperatively with an aesthetically acceptable vagina measuring 4 cm in width and 14.5 cm in length (Fig. 4). She started her sexual intercourse 3 months postoperatively and by the fourth month, secretions lessened significantly.