The 16th edition

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.

The 15th edition

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.

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The 14th edition

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

OPD.S.736.AT (6)

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The 13th edition

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.

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The 12th edition

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