The 12^th edition

In some patient  that  have long  penis we will try  to use  the  penile  flap to  be  the  anterior  vaginal wall. To  avoid  the graft contractionb at the  anterior vaginal  wall and  to  gain the  benefit  of flap elasticity, the new design of penile flap has been deveioped. It take  about 1 year  to get  this  setting prior to  failure of  other 2 setting.  The anterior penile flap is  separate to make  the long labia minor and  the  distal end turn to  construct  the vaginal  wall next to  the  urethral opening. In  this  setting the  urethal opening is quite stable and  the vaginal opening is wider and more elastig. So  the  dilation and sexual  intercourse will be  much easier.

The 2^nd version of the 12nd  edition

As we set  the  urethal flap  and  graft  in the new design, we modify  the  technique of tissure  setting. We  interpose  the urethal opening and  the distal penile flap with  the urethal graft. Therefore  the opening of valva  consist of mucosal tissue  that have slippery surface which facilitate  the dilation and insertion

MTF surgery the 11^th   edition

The  development  of edition  11th  is to correct  the problem   in case  of  short penis and  it  is  the  development  from  the  9^thedition . We can make  longer labial lip to  be more pimilar to  the  congenital labia.

The lining of vagina consisted of scrotal graft making  the anterior wall from the opening of valva  and  long scrotal flap a and graft to make  posterior wall. The  posterior  flap is  raised as parineal artery- pedicle flap , so  the  circulation to the  distal end  come from the 2 arteries from the groove of penile crus. As a result , the skin of the beginning of  posterior flaps can be cut medially to make  a space of  labia minor, then we can make  the  end  of labia come  closer  to be more similar to the female anatomy . Any way now  we cannot make  the true posterior fouchette because  of  the shortness  of  the tissue.

All of penile  skin  is  used  just for  the  labia minor reconstruction , the settit  of  upper half of labia  is the same  as the 9^th edition but  for the  lower half, instead of hanging from the  anterior vaginal  wall, the labia attach  the side wall of  vagina  by 2 special designflap …from the posterior flap.

The developed pedicle posterior is  the  key to make the longer labial lip to  make  more esthitic vagina.

The 2^nd version of  the 11st  edition

Since  there  is a lot  of change  happened in the  11st edition  so  a lot of  minor adjustment has been created.  At  the first time ,   we use a part of the posterior  flap to line  the  beginning of  anterior flap but since we donot  have a lot of tissue, the opening of  vagina is too  norrow  and  cause  the problem of  dilatiion. Then we use  the  scrotal graft more  to  the  beginning of  ant wall  but the result  of   graft contraction result  the  narrowing of  the  vg opening and pulling of  the urethal.

So now we modify  the  setting  of  the  urethal mocosa . the uretral tube is  separated in a new designed, getting  more tissue  to  the valva area and  less  tissue  to  the critoris  area. So  the  crus  of  critoris come closer  together to be  more natural and most mucosal  tissue move  to postrior  to  be the  beginning of  anterior vaginal wall. Since  the  tissue  is  a long flap, so  the   graft  contaction will  not  effect  the  urethal and  since  the  lining is mucosal tissue  that is  more similar to  female  vagina.the surface of  the  anterior wall  is   slipper and  natural, so  it  facilitate the sexual intecouse  and  dilation. The urethae flap can be  effectively used to   correct the problem of narrowingof valva.Moreover  at  the side of urethal flap, we can add the  urethral mucosal graft in the  new design that  can make  the  valva wider and  correct  the  problem of  inadequate  tissue at the anterior wall

This  setting  of urethrae is  not new. It   has been done  in europe for  more  than 20 years  but  indifferent  setting  from ours. The result is  excellent  for  functional vagina because  it make  the sexual  intercourse and dilation easier. Anyway some one  will  notice  the  redness  of  the urethrae  at  the  beginning of anterior  vaginal wall and  look  not esthetic. But  after  4 0r 5  monthes,  the  redness  will  turn to  be  pink color and  look  more  natural.

The risk  of  this  setting is  the separation of  the wound of labia minor if  the penis  is  too short an is  not easy  in the  setting for the primary colon vaginoplasty.

The 10^th edition

For  the 9^th we designed to  make  functional vagina but it    suit  to   asian people  that  have  less hair. For  the 10^th edition,  we put  almost total  graft to  the  vaginal  wall to  get rid  of  hairs, The posterior  wall  is  very short  and  need  no vascularised. It has less feeling, less elasticity but get more benefit  in the hair free vagina.

Since we  do not  need the tissue  for  anterior vaginal wall, so  we can use  the  penile flap  to  make  a longer labia to cover  the side of vaginal opening.

The problem of the 10^th is the contraction of  the  graft  that stay beneath the  urethral opening , the contracted graft pull down  th e opening of urethane to  the  Vg cavity. In some  cases the opening  turn to  inside of vagina .