Objectives: Propose the alternative option of neovaginal lining tissue in male to female gender reassignment surgery (MTF GRS) by free small intestinal graft. Jejunal part is preferred.
Introduction: Vascularized rectosigmoidal colon flap (or less popular ascending colon flap) has been an alternative option for primary and secondary vaginoplasty in MTF GRS. But some problems are arising such as excess mucosal discharge, ring constriction at junction between colon and penile-perineovulva tissue, relative small diameter of colon comparing with wide neovaginal canal led to vaginal constriction. The author looks for the other option and found that free jejunal musculomucosal graft is a favorable one.
Materials / method: The MTF GRS is divided into 2 stages. The first stage is almost complete but not inset lining tissue inside neovaginal canal yet. PU foam is packed inside neovagina and connected to Vacuum assisted closure device. 3 days later, the second stage is set for free jejunal musculomucosal graft insetting. 9 inches of jejunal small intestine is resected.The graft is irrigated with Betadine. Adventitial layer and mesentery fat is dissected out and only musculomucosal layer is left. This tube graft is split longitudinally, unfold, place over the stent, suture, inset into neovagina and keep for 4 days.
Results: The jejunal musculomucosal graft lining along neovaginal canal is well-taken. The color of mucosa is pale red. There is no excessive mucosal discharge. However, regular vaginal dilation must be continued for 6 months after surgery to avoid vaginal constriction.
Conclusion: The technique of free jejunal musculomucosal graft is less complicated than Rectosigmoidal colon vaginoplasty, laparoscope is only optional not mandatory. There is no worry of hair growth inside neovagina comparing to scrotal skin graft lining. The neovagina is more moisture than scrotal skin graft and no excessive mucosal discharge like Rectosigmoidal colon flap. However, delayed graft for 3-6 days after the first stage MTF GRS is recommended to insure highest chance of graft
survival and taken.
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