XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Abdominal Approach to the Anterior Vaginal Flap Elevation

TAKAMATSU, AKO Japan
Co-authors: T. Harashina, Y. Inoue, K. Kinoshita & O. Ishihara (Japan)
E-mail: accot@saitama-med.ac.jp

The anterior vaginal flap is widely used for neourethra construction in FTM transsexuals. Despite transvaginal elevation of the flap to be technically difficult because the appropriate plane for dissection between the vaginal wall and the bladder/urethra is hardly identified, the flap is generally elevated transvaginally except the Meyer (1986) performed one-stage phalloplasty for FTM transsexuals. Our surgical procedures for the flap elevation through the abdominal approach will be presented.

Patients and Methods: We performed 3-stage surgeries in 6 FTM transsexuals. In the first state a transabdominal oophoro-hysterectomy and elevation of the anterior vaginal flap performed by the gynecologists. Transvaginally the completion of the flap, the neourethra construction and the close of the vagina are performed by plastic surgeons. Phalloplasty with the free deltoid flap is performed in the second stage, and insertion of the rib cartilage in phallus and placement of testicular prosthesis are in the third stage.

Results: 1) flap size: 2-3 cm in width (mean 2.8 cm) and 6-10 cm (mean 8 cm) in length. 2) more than 50 percent of the flap in length was elevated transabdominally. 3) total blood loss: 270-730 ml (mean 306 ml). 4) major fistula formation in 1 patient (by inadequate postoperative rest). 5) no damage to the bladder and urethra. The sufficient size of the anterior vaginal flap was achieved and vaginectomy could be carried out safely from above under direct vision.