Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China.
Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China.
Aesthet Surg J. 2022 Aug 1;42(8):907-917. doi: 10.1093/asj/sjac039.
Existing classifications of the clitoral hood-labia minora complex (CLC) have neglected its integrity and anatomic variation, resulting in failure to optimize approaches tailored to individuals.
The aim of this study was to present a new classification system for comprehensive evaluation of variations of the CLC and to introduce a simple surgical approach for the fused type.
Anatomic variations of the CLC were classified into 3 types: isolated labia minora or lateral clitoral hood hypertrophy (Type 1); conventional combined hypertrophy (Type 2); and fused lateral clitoral hood and labia minora (Type 3). A modified procedure for the fused type was performed in 4 steps: the anterior border of labia minora was defined first, then the hypertrophic lateral clitoral hood and labia minora were each removed separately, and finally the junction region was trimmed. Satisfaction questionnaires were administered during follow-ups.
Among all 301 patients (602 sides), Type 2 was the most common variation (285 sides, 47.3%). Type 3 variations in 67 patients (105 sides, 17.5%) were identified, and 77.6% of these patients answered the questionnaires 3 months after surgery. For patients with type 3 variations, the satisfaction rate in the 4-step excision group was 91.7%, which was significantly higher than that in the wedge excision group (56.3%) (P = 0.01). The complication rate of the 4-step excision was 2.5%.
Preoperative evaluation based on the new classification facilitated recognition of variations of the CLC, especially of the fused type. The 4-step excision is a simple, effective, and safe approach to treat the fused variation with high satisfaction.
现有的阴蒂包皮-小阴唇复合体（CLC）分类方法忽视了其完整性和解剖学变异，导致无法针对个体优化方法。
本研究旨在提出一种新的分类系统，用于全面评估 CLC 的变异，并介绍一种针对融合型的简单手术方法。
将 CLC 的解剖变异分为 3 型：小阴唇或外侧阴蒂包皮单独肥大（1 型）；传统的联合肥大（2 型）；融合的外侧阴蒂包皮和小阴唇（3 型）。对融合型采用 4 步改良手术：首先确定小阴唇的前边界，然后分别切除肥大的外侧阴蒂包皮和小阴唇，最后修剪交界区。在随访期间发放满意度问卷。
在所有 301 例患者（602 侧）中，最常见的变异是 2 型（285 侧，47.3%）。在 67 例（105 侧）患者中发现了 3 型变异，其中 77.6%的患者在术后 3 个月回答了问卷。对于 3 型变异的患者，4 步切除组的满意度为 91.7%，明显高于楔形切除组（56.3%）（P=0.01）。4 步切除的并发症发生率为 2.5%。
基于新分类的术前评估有助于识别 CLC 的变异，特别是融合型。4 步切除是治疗融合型的一种简单、有效、安全的方法，满意度高。
