Application of Embryonic Equivalents in Male to Female Sex Reassignment Surgery

Abstract

Introduction: Gender Identity Disorder is a unique human condition that is lassified behaviourally but treated medically by hormones and surgery. Treatment is self-rehabilitation through a multidisciplinary team approach, with the final step of the traditional triadic sequence being sex reassignment surgery. Plastic and Reconstructive Surgeons most familiar with body image change surgery and

its psychology often provide the ultimate step in this complete

human transformation¹.

Aims and Objectives: Our study aims to evaluate the Aesthetic and Functional outcome of Male-to-Female Sex Reassignment Surgery using Penile-scrotal skin flap Vaginoplasty by applying embryonic genitalia equivalents in

transsexuals.

Aesthetic factors evaluated are.

1. Appearance of newly created external genitalia as a

whole.

2. Introitus created by suture-scrotopenile flap specific

technique.

Functional factors evaluated are,

1. Passing of urine in squatting position.

2. Adequacy & service of neovagina created.

3. Erectile response of the Clitoral mount.

Material and Methods: The study was conducted in

the Department of Plastic Surgery, Government General

Hospital, and Madras Medical College over a period of 30

months from October 2014 to March 2017.

20 Transgender patients after psychological screening,

following the Benjamin criteria for the selection of patients,

were subjected for Sex Reassignment Surgery.

Surgical Technique: Neoclitoral mount was

reconstructed using the retained crura of the conjoined

corpora cavernosa. Introitus and Labia minora from

glaberous degloved penile skin (Both equivalents from

urethral folds). Vagina was designed posterior to the bulb of

the penis and anterior to the perineal body with the

invagination of the degloved penile skin making the anterior

3/4th circumference of the neovagina and para-raphal skin

forming the posterior 1/4th circumference of the neovagina

(all derivatives of the sinovaginal bulb). Scrotum was reduced

to form the labia majora (embryonic equivalents).

Observation and Results

Age of the patients ranged from 21years to 42years

(average of 27.4 years).

The maximum length of neovagina obtained was 10

cm and the minimum being 7 cm with an average of

8.5cm in 20 cases.

The neo vaginal reconstruction with urethrostomy

was evaluated by the patient and an independent

plastic surgeon aesthetically and functionally.

Post-op complications in the early post-op period

was, oedema in 5 cases, neovaginal lining apical

necrosis in 4 cases, wound dehiscence in 3 cases

and vaginal vault prolapse in 1 case.

Conclusion: The aesthetic and functional outcomes of all the

patients were good. All patients were relieved of their Primordial

feminine tension and satisfied with the surgery. Their personality,

lifestyle and self-esteem improved remarkably following surgery.