The 9^th edition 

In this edition  we study more on, the  vascular  and  nerve supply  of  the scrotal flap to  make  the  posterior  flap. We preserve and meticulous dissected the flap to  make  more senstive  and survived posterior flap .The posterior flap will be  thicker  and  perineal vss is dissected to the flap until  the separation of deep artery and  dorsal  artery. After the  artery is  brought  togeter  to  the flap, less congestion ,less hematoma  and less end necrosis  occur, Anyway  this  type  of  dissection cause  more intra op bleeding. As we got the  good survival of  flap,we can modify  the  flap in  the  setting of  edition 11st and  12nd.

We concentrate more  on flap setting, the posterior flap is  set deeply to  the longitudinal layer of  the rectum. The anterior flap is  fixed to  the posterior bladder wall and prosthetic capsule. The labia minor is more dissected and  set  in the new style  of 3 point setting. We  separate  the midline of  anterior flap  to make  a long  midline  cleft and fix to  the prostate to  get  the  longer  and  more complete structure of labia minor. Any way  the  labia minor  end at  the  anterior  vaginal  wall  and does not  cover on  the side  of  vaginal opening.

The  penile  flap is  meticulous dissected to  make  the  very narrow pedicle  and  the narrow  clitoral  hood  can be  fixed to  the  pubic symphisis to  make  a permanent hood. The tunica albuginia get a new  design to act as  the  port of clitoral base to  make  it  stay  in midline.

The 9^th is  one  of a perfect design  that  get  the concept  from  the  house  building and foundation. We set  the foundation first  to  the  strong foundation area as periostium…..the  uretral is  set first instead of  last ,then the valva , the hood  and lateral wall of labia minor was set  to the  priosteum and stump of penile  crus, Then   the pile is  complete , other structure  will  be attached  to  the pile.

With this concept  we  can control  the external appearance  of valve and it  will stay  in  midline  because the corresponse part of tissue will fix to  the proper part of bone.

Anyway,some one might need  the  more aesthetic correction of the labia to  be  longer that can be done  after 3  or 4 monthes.

The 8^th edition

This edition we pay attention  in  thre vaginal pocket , packing  and  drainage system . Since  in our technic  the  anterio  vagina wall consists of  more graft and  posterior wall  consist  of  more flap. So  the  packing  should not  be  tight  to avoid flap necrosis and  not  too  loose to  avoid graft lost.We find  that thight packing  is not  so good  in our setting  because it conpresses the vascular  of  the  posterior flap  and cause a lot of flap necrosis then result inadequte depth of neovagina after  completely healing.  the  The concept  is  that  right after operation  the pocket  will  be very swelling  in a small cavity ,  make  the pocket  thight and result better graft survival.The drain  is change from normal Fr12 PVC radivac  drain to silicon15 mm fruited drain , so  the drain will funtion for  all 6 day  before  we take out  the drain. We found  that the good fruited drain can make  the  big change in flap  and  graft survival because  the  less correction and hematoma. Furthermore  thevaginal pocket is deeper  and  wider dissected to  the  Denonvier layer and retroperitoneal pocket that more potential space  and  give more space  than intraperitoneal space.

WE can say  that  the factor of deep pocket into retroperitoneum,adepockin ang very good drainage  is a key of depth success.

The7th Edition

This edition we focus  on  the  setting  of  urethrae. We  try  to  make  the long anterior urethral flap  but  in some  patient who have  a thick  urethrae wall will get some  problem of  urethral swelling during early post  operation peroid and the setting is uncontrollable. But  if  the  flap is  too thin it  will  be  to friable to  setand cause opening stricture. So we use  the  medial thick ness  in  the new  edtion  and fix  the  urethral flap to the  anterior perineal wall. Most of  urethral tissue  lie  on the perineum  not the vagina wall.

The 4^th edition

The  4^th edition is  the  era of   new concept  of  flap fixation to  make  to  fixation  last longer  and the  appearance of  labia minor  more defined for  a  long time. Now we can get rid  of  the  hair along labia minor, inside the critoris and especially hood of critoris. Anyway,the tecnique  cause more tissue slough, the technique  has been modified for a while until getting  better result.

The 5^th Edition

We are still unsatisfied  about  the  appearance of  critoris. During  this time the  anatomy  of  the  gland penis  was reviewed and the new  dissection and  setting was  deveoped. After 1 month all  the  cases were oprerated in  the new style of critoris because  we can  get  the  good  setting  , good feeling  and better aesthetic result. The uretrae is still set  with thick flap.

The 6^th adition

Even we reduce  the  spongy tissue around  uretrae. In long term follow up, some  one  still have  problem of  enlargement of sponge  mass aterior to introitus during arousal peroid. So we  remove  more tissue with the new tecnique to get rid  of  the  mass that obstruct  the  neovaginal canal.