Center Specialized in Breast Surgery and Transgender Surgery, Cali, Colombia (Dr. Rodríguez).
Burn Treatment Center, Dr. José Frota Institute, Fortaleza (Mr. Lima Júnior).
J Minim Invasive Gynecol. 2020 Nov-Dec;27(7):1474-1475. doi: 10.1016/j.jmig.2020.02.017. Epub 2020 Mar 3.
Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth.
Stepwise demonstration of the procedure with narrated video footage.
Transgender health clinic.
A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period.
Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.
男性到女性性别转换的阴道成形术中，阴茎皮肤不足很常见。这一问题可以通过使用阴囊皮瓣来补偿，但存在毛发生长的缺点[1]。在最近的研究中，尼罗罗非鱼皮成功地用于 Mayer-Rokitansky-Küster-Hauser 综合征[2,3]和阴道狭窄[4,5]的手术治疗。本研究旨在描述一种使用尼罗罗非鱼皮作为生物相容性移植物的新型原发性阴道成形术技术，以确保足够的阴道深度。
分步演示手术过程，并配有解说视频。
跨性别健康诊所。
一名 29 岁的性别焦虑患者因性别认同手术需求被转至我们的办公室。体格检查显示正常的男性生殖器，阴茎长 14 厘米。手术前，获得了机构审查委员会的批准和患者的书面同意。在睾丸切除术、阴茎解体、会阴解剖和尿道成形术后，制备空心尼罗罗非鱼皮模具，并将其缝合到剩余阴茎皮肤的远端边缘。将该结构反转，覆盖新形成的通道。然后将手工制作的可充气阴道模具填充到新腔中，用大阴唇的缝线固定。最后进行阴唇整形术和阴蒂成形术。7 天后，取出可充气模具，并开始使用逐渐增大的扩张器。3 周后，检测到长 16 厘米、可容纳 2 指宽的新阴道。此时，尼罗罗非鱼皮已完全被吸收到新阴道黏膜中。术后早期无并发症。
尼罗罗非鱼皮是一种安全、低成本、易于使用的生物相容性材料，可能是阴囊皮瓣的替代选择，用于男性到女性性别转换的原发性阴道成形术中的新阴道扩张。然而，需要进一步的研究来证实这一断言。
