For some ones who has big penis that the skin form penile shaft is too wide or ones who regularly strap the tip of penis to the buttock crease to hide the penile shaft during dressing as a woman that will make the penile skin wider and longer, if we use all parts of the penile skin to make the labia minors, the labias will be to wide and too thick which not be a good esthetic appearance of the labias.
The 16th edition is a reversion of the 15th edition. For this technic, we separate the penile skin into 2 parts, one to make the labia minors and the outer part to make the inner side of labia majors. We need the proper design on the penile skin to make the proper size of the labia minors, while the rest of penile skin can help in reducing the tension of the labia majors ,so we can get more scrotal skin graft to make the deeper neovagina. The labia majors are usually made by scrotal skin ,but in the type half of them from the penis and the other half from the scrotum.
For some patients who have very small penis or ones who have circumcised by the technic of high level circumcision may have a severe shortness of prepuce skin that is not enough to make a good shape of labia minors. In this group the labia will be short and narrow ; most of the time, they cannot cover the vaginal opening. Even they can cover the opening , because the shortness of tissue to make the inner labia , sometime they cause narrowing of the introitus and cause difficulty during dilatation and sexual intercourse.
In order to correct that problem, in some case that we do not use the scrotal skin such as primary colon vaginoplasty or in case that the scrotal skin is very long or in case that the patient decides to use skin graft from the groin crease or lower abdomen for making the deeper neovagina, the scrotal skin flap can be designed to be the outer layer and the lower part of inner side of labia minors that we call posterior forchette. For this 15th edition, the whole outer side is totally made by the scrotal skin, while the inner layer is divide into 3 parts; the upper part by the small remnant of prepuce, the middle by the small penile shaft ( design as turnover flap)and the lower part by the excess tissue of the scrotum. Because this is the technic of flap for reconstruction, the final outcome of the labias will be a little bit too thick and too wide at the beginning. Even they will be smaller in 2 or 3 months, in some cases, they might need a later revision to make them smaller and flat after 6 months.
The edition 14th
There are some problems in the patients who have a small penis or ones who have circumcised is the lack of prepuce skin to make a good shape of labia minora. In this group the labias will be short in length and width ; most of the time, they seldom cover the vaginal opening. Even they can cover the opening , because the shortness of tissue to make the inner labia , sometime they cause narrowing of the introitus and cause difficulty during dilatation and sexual intercourse.
The 14th edition will be an option to make the labia minor in ones who are circumcised or have short penis in the minor degree. The outside labia is made by skin from penile shaft ,and the inner side is make from 3 sorts of tissue; the upper part is prepuce that will be very short but can connect the clitoris with the lower tissue, the lower part is the remnant of lower part of penis designed as reverse flap, the middle part is covered with the graft from scrotal skin or urethral mucosa. The urethral graft will be red for 3 to 4 months; then it will be pale and pink and look more natural. The benefit of urethral mucosa is self-lubrication that will facilitate sexual intercourse but take a long time to look natural and, because in the small penis , the urethral mucosa will be short too, in some case the graft will not be enough to make the good result. The scrotal graft is another option in some case that more extra scrotal skin can be harvested or some grafts that plan to make the vagina can be shared. For this technic, the labia is not self-lubricated , but the scrotal graft can be taken bigger and longer ,so we can get the wide and long skin graft enough to cover the large gap between the upper and the lower part of the inner labias. The benefit of the scrotal interpose graft is more tissue to fill the gap that can make a longer and wider labia but still very thin in order to facilitate sexual intercourse and dilation and get the good feature of the labias. It will take 2 or 3 months to be completely heal and look more natural.
Because the technic is the basic of graft technic, the labia will be thin and look more esthetic ; compare to the technic of scrotal flap in the edition 15. Since the outer flap have to be very well vascularized to feed the graft that we put in, it need a good delicate surgical skill to raise the penile flap because if the penile flap is not survived, the graft will not survived too ;that will make the flap and graft slough and turn to be short labias. Anyway, this is an inventional technic and the only technic nowadays that graft can be used for the labias to make them very thin and long to complete the concept of the beautiful labias.
In this edition we will call the labia interposition with urethral graft as 14a,with scrotal graft as 14b
The Edition 13th
The 13th edition is designed for the primary colon vaginoplasty to solve the problem of current technique of the primary colon vaginoplasty. The primary colonvaginoplasty is the surgery that we make neovagina from the colon that will connect to the outer penile or scrotal skin to made neovagina in anyone who has never had the surgery done before. This surgery was done more than 10 years but still have some minor and major problems.
The current problem is the narrow introitus because the shortness of anterior skin flap, the visible of redness of colon mucosa in the lower part of vaginal opening and the disability to make the labia minor to be long enough to cover the introitus and down enough to form the posterior commissure. The 13th edition focus on the new design of posterior flap to get enough scrotal skin area and mold to a new shape on the side wall of neovagina to conceal the junction of skin and mucosa to hide the mucosa redness. Because of the large area of scrotal skin that include in the posterior flap by a new design , the opening of neovagina will be widen to help dilation and sexual intercourse more comfortable. More over the new design can get extra space for the labia minor to be set on the side and posterior area of the vaginal opening to make a esthetic labia minora.
The invention of the 13th edition is the revolution of the colonvaginoplasty technic because the stricture of junction of colon and skin make the problem during dilation and sexual intercourse.
The 13th edtion can complete the function of colonvaginoplasty and hide the redness that made the strange appearance of neovagina by hiding with side wall skin flap and the long labia minora,then make the external appearance more esthetic.
The 12th 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 2nd 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