From the Department of Urology and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2020 May;145(5):984e-987e. doi: 10.1097/PRS.0000000000006796.
Penile inversion vaginoplasty involves creation of vulva and a vaginal canal. Few studies describe techniques for creating aesthetic vulvar components, particularly the clitoral hood and labia minora. The authors present their approach to primary vulvoplasty, aiming to achieve the following: (1) labia minora that are well-defined and three-dimensional; (2) labia minora that frame the introitus; (3) sufficient clitoral hooding; (4) a patent introitus that appears closed at rest; and (5) prominent labia majora. In this technique, the labia majora are created by first pulling the superolateral scrotal skin inferiorly and medially toward the perineum. The labia majora incisions may be made laterally, medially, or both laterally and medially, dependent on the amount of penile and scrotal skin available. Initial approximating sutures are placed to anchor the labia inferiorly, and then excess skin is removed medially. The surgeon should avoid excess defatting of the labia majora, which are subject to initial edema and often atrophy with time. The preputial or distal penile shaft skin is used for the clitoral hood and medial aspect of the labia minora, with proximal penile shaft skin used for the lateral surface. The penile skin used for the lateral aspect of the labia minora must be pulled inferomedially toward the perineum, to create a narrow, tapered appearance and avoid effacement of the labia minora. Interrupted horizontal mattress quilting sutures are used to define the labia minora as distinct subunits. By considering homologous structures and anatomical subunits, we are able to create well-defined, aesthetic vulva in trans women and nonbinary individuals.
阴茎反转阴道成形术包括外阴和阴道管的创建。很少有研究描述创建美学外阴组件的技术，特别是阴蒂包皮和小阴唇。作者介绍了他们的原发性外阴成形术方法，旨在实现以下目标：（1）定义明确且三维的小阴唇；（2）小阴唇框住入口；（3）足够的阴蒂包皮覆盖；（4）入口通畅，静止时看起来闭合；（5）突出的大阴唇。在这种技术中，首先将阴囊的超外侧皮肤向下和向内侧拉向会阴，以创建大阴唇。大阴唇切口可以在外侧、内侧或外侧和内侧同时进行，具体取决于阴茎和阴囊皮肤的数量。最初的近似缝合线用于将阴唇下部固定，然后从内侧切除多余的皮肤。外科医生应避免过度去除大阴唇的脂肪，因为大阴唇会出现初始水肿，并且随着时间的推移常常会萎缩。使用包皮或阴茎远端轴皮肤作为阴蒂包皮和小阴唇的内侧，使用近端阴茎轴皮肤作为外侧表面。用于小阴唇外侧的阴茎皮肤必须向会阴方向向下和向内侧牵拉，以形成狭窄、锥形的外观，并避免小阴唇消失。间断的水平褥式缝合线用于将小阴唇定义为不同的亚单位。通过考虑同源结构和解剖亚单位，我们能够为跨性别女性和非二元个体创建定义明确、美观的外阴。
