Tim H J Nijhuis1, Müjde Özer2, Wouter B van der Sluis2, Muhammed Al-Tamini2, Ali Salim3, Philip Thomas4, James Bellringer5, Mark-Bram Bouman2. 1. Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amphia Hospital, Breda, the Netherlands. Electronic address: t.h.j.nijhuis@gmail.com. 2. Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUMC, Amsterdam, the Netherlands. 3. Department of Plastic and Reconstructive Surgery, Kaiser Permanente, San Francisco, CA, USA. 4. Department of Urology, Nuffield Health Brighton Hospital, Brighton, United Kingdom. 5. Deparment of Gender Surgery, Parkside Hospital, London, United Kingdom.
Abstract
BACKGROUND: Penile inversion vaginoplasty is a commonly performed genital gender-affirming procedure in transgender women. The creation of an adequate functional neovaginal depth in cases of too little usable penile skin is a challenge. The bilateral pedicled epilated scrotal flap (BPES-flap) can be used as an easy adjunctive technique and may serve as a tool in the surgical armamentarium of the gender surgeon. AIM: To describe the use, dissection, design subtypes, and surgical outcomes of the BPES-flap in vaginoplasty. METHODS: Perioperative considerations and different flap design subtypes were described to illustrate the possible uses of the BPES-flap in vaginoplasty. A retrospective chart study was performed on the use of this flap in 3 centers (blinded for review purposes). OUTCOMES: The main outcome measures are description of surgical technique, flap design possibilities, and postoperative complications. RESULTS: A total of 42 transgender women were included (median age: 28 years (range 18-66), mean body mass index: 24.5 ± 3.5). The mean penile length and width preoperatively were 9 ± 3.1 and 2.9 ± 0.2 cm, respectively. With a mean follow up of 13 ± 10 months, total flap necrosis occurred in one case (2.4%). Partial flap necrosis occurred also in one. Neovaginal reconstruction was successful in all patients with a mean vaginal depth of 13.5 ± 1.3 cm and width of 3.3 ± 1.3 cm. Partial prolapse of the neovaginal top occurred in 3 patients (7%). CLINICAL IMPLICATIONS: The BPES-flap is a useful addition to the arsenal of surgeons performing feminizing genital reconstructive surgery. STRENGTHS & LIMITATIONS: Strenghts comprise (1) the description of the surgical technique with clear images, (2) completeness of data, and (3) that data are from a multicenter study. A weakness is the retrospective nature with limited follow-up time. CONCLUSION: The BPES-flap is a vascularized scrotal flap that can be raised on the bilateral inferior superficial perineal arteries. It may be used for neovaginal depth creation during vaginoplasty and may be quicker to perform than full-thickness skin grafting. Nijhuis THJ, Özer M, van der Sluis WB, et al. The Bilateral Pedicled Epilated Scrotal Flap: A Powerful Adjunctive for Creation of More Neovaginal Depth in Penile Inversion Vaginoplasty. J Sex Med 2020;17:1033-1040.
BACKGROUND: Penile inversion vaginoplasty is a commonly performed genital gender-affirming procedure in transgender women. The creation of an adequate functional neovaginal depth in cases of too little usable penile skin is a challenge. The bilateral pedicled epilated scrotal flap (BPES-flap) can be used as an easy adjunctive technique and may serve as a tool in the surgical armamentarium of the gender surgeon. AIM: To describe the use, dissection, design subtypes, and surgical outcomes of the BPES-flap in vaginoplasty. METHODS: Perioperative considerations and different flap design subtypes were described to illustrate the possible uses of the BPES-flap in vaginoplasty. A retrospective chart study was performed on the use of this flap in 3 centers (blinded for review purposes). OUTCOMES: The main outcome measures are description of surgical technique, flap design possibilities, and postoperative complications. RESULTS: A total of 42 transgender women were included (median age: 28 years (range 18-66), mean body mass index: 24.5 ± 3.5). The mean penile length and width preoperatively were 9 ± 3.1 and 2.9 ± 0.2 cm, respectively. With a mean follow up of 13 ± 10 months, total flap necrosis occurred in one case (2.4%). Partial flap necrosis occurred also in one. Neovaginal reconstruction was successful in all patients with a mean vaginal depth of 13.5 ± 1.3 cm and width of 3.3 ± 1.3 cm. Partial prolapse of the neovaginal top occurred in 3 patients (7%). CLINICAL IMPLICATIONS: The BPES-flap is a useful addition to the arsenal of surgeons performing feminizing genital reconstructive surgery. STRENGTHS & LIMITATIONS: Strenghts comprise (1) the description of the surgical technique with clear images, (2) completeness of data, and (3) that data are from a multicenter study. A weakness is the retrospective nature with limited follow-up time. CONCLUSION: The BPES-flap is a vascularized scrotal flap that can be raised on the bilateral inferior superficial perineal arteries. It may be used for neovaginal depth creation during vaginoplasty and may be quicker to perform than full-thickness skin grafting. Nijhuis THJ, Özer M, van der Sluis WB, et al. The Bilateral Pedicled Epilated Scrotal Flap: A Powerful Adjunctive for Creation of More Neovaginal Depth in Penile Inversion Vaginoplasty. J Sex Med 2020;17:1033-1040.
Authors: Samyd S Bustos; Valeria P Bustos; Andres Mascaro; Pedro Ciudad; Antonio J Forte; Gabriel Del Corral; Oscar Javier Manrique Journal: Plast Reconstr Surg Glob Open Date: 2021-03-19
Authors: Müjde Özer; Sahaand Poor Toulabi; Alessandra D Fisher; Guy T'Sjoen; Marlon E Buncamper; Stan Monstrey; Marta R Bizic; Miroslav Djordjevic; Marco Falcone; Nim A Christopher; Daniel Simon; Luis Capitán; Joz Motmans Journal: Sex Med Date: 2021-12-28 Impact factor: 2.491