TY - JOUR
T1 - Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft
T2 - To Graft or Not to Graft?
AU - Buncamper, Marlon E.
AU - Van Der Sluis, Wouter B.
AU - De Vries, Max
AU - Witte, Birgit I.
AU - Bouman, Mark Bram
AU - Mullender, Margriet G.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-Thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Methods: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-Thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. Results: A total of 100 patients were included (32 with and 68 without additional full-Thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). Conclusions: The authors can confirm neither of the suggested arguments, for or against full-Thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-Thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient-And physician-reported aesthetic or functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
AB - Background: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-Thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Methods: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-Thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. Results: A total of 100 patients were included (32 with and 68 without additional full-Thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). Conclusions: The authors can confirm neither of the suggested arguments, for or against full-Thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-Thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient-And physician-reported aesthetic or functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
UR - http://www.scopus.com/inward/record.url?scp=85014097127&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/PRS.0000000000003108
DO - https://doi.org/10.1097/PRS.0000000000003108
M3 - Article
C2 - 28234830
SN - 0032-1052
VL - 139
SP - 649e-656e
JO - Plastic and Reconstructive Surgery
JF - Plastic and Reconstructive Surgery
IS - 3
ER -