The split labium minus flap graft technique.

The split labium minus flap graft technique was used to restore tissue volume and therefore elasticity into the bladder neck area of vagina in eight patients. Three full-thickness vaginal incisions were made, a longitudinal incision extending from external urethral meatus to 3-4 cm beyond the bladder neck, and two transverse incisions, one just below the external urethral meatus and the other at the level of the bladder neck. The vagina, urethra and bladder neck were mobilized widely and the suburethral flaps rotated downwards, leaving a bare area below the urethra. A transverse incision was made across the base of one labium minus (LM) and the incision carried up on each side to the ridge of the LM. The inner wall was dissected clear of the outer wall, creating a flap. This was then rotated into the bare area formed by dislocation of the suburethral vagina. The flap was attached to the pubococcygeus muscles laterally, to the external meatus superiorly and to the vaginal skin inferiorly. All the cut surfaces of the vagina and LM were joined with 00 Dexon sutures. Postoperative pain was minimal. All patients were discharged within 48 h, and there was excellent anatomical restoration at 6 weeks' follow-up. The technique works well in patients with adequately large labia minora, and has potential uses for patients who have deficient vaginal tissue in the hammock or bladder neck areas of the vagina.