阴股沟皮瓣阴道再造术12例分析

Twelve Cases of Vaginal Reconstruction Using Neurovascular Pudendal-thigh Flaps

目的 对应用阴股沟皮瓣进行阴道再造的经验进行总结。方法 以阴唇后动脉外侧支为血管蒂 ,在两侧阴股沟区掀起阴股沟皮瓣 ,皮瓣 9cm× 4cm～ 14cm× 5cm ,通过大阴唇皮下隧道转移至阴道前庭 ,相对缝合形成皮管 ,推入尿道、直肠间隙的腔穴中形成阴道。共为 12例患者实施阴道再造。结果 1例因术中造穴时损伤直肠导致阴道直肠瘘 ,1例因感染致一侧皮瓣坏死 ,二期修复成功。其余 2 3个皮瓣全部成活 ,随诊 3个月至 8年 ,再造阴道光滑、无缩窄 ,横向可容纳两指 ,深度约9～ 10cm。结论 应用阴股沟皮瓣进行阴道再造 ,具有皮瓣血运丰富 ,解剖简便易行 ,再造阴道无继发挛缩并带有会阴部感觉 ,供区较隐蔽 ,术后少有继发瘢痕畸形的优点。

Objective To summarize the experience in vaginal reconstruction using neurovascular pudendal thigh flaps. Methods The pudendal thigh flaps lateral to labia majora with the external branches of labial posterior blood vessels in the pedicle were elevated and brought to the midline through tunnels formed under labia majora. The two flaps were then sutured together to create a new vagina. Flap size varied from 9 cm×4 cm to 14 cm×5 cm. Results In twelve cases aged 14 to 44 years including congenital absence of vagina , testicular ferminization syndrome and transsexual patients a new vagina was constructed with neurovascular pudendal thigh flaps. One patient developed complete necrosis of unilateral flsp, followed by formation of rectovaginal fistula. In other patients the flaps all survived and the neovagina was spacious and quite deep. Conclusion The vaginal reconstruction using pudendal thigh flaps is one of the best methods of vaginoplasty. The technique is simple and reliable. The flap has good blood supply and no stents or dilators are needed after operation. The donor site is hidden with little secondary deformity. The neovagina has a natural angle for intercourse and is sensible.