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.