The development  of  bcs  SRS  technique

This is  the  legend  of the  SRS  . SRS is a sophisticated  and  specialized plastic  surgery procedure. Even the limited  tissue  available,  the  operation  is still  developed . in  the  beginning  the  aim  of  the  operation  is  just  to  make  an  adequate depth  and  width of  neovagina but  now aday more people  concern about the  aesthetic  appearance  of  outer  and inner vagina. Therefore, to  develop the  better result, the  surgeon  need  to recognize the  tecnique  of  tissue  transfer especially flap-graft dissection  and setting.

The 1st edition

The  1^st edition  to  the  3^rd  edition  , we  started  from  the  year  1999 to  2004 the  technic  is  quite simple  but very  safe  in  flap  survival.

In  the  1^st edition ,the  critoris  is  still  flat  and  the  critoral  collumn  is  very  wide, it  is  the  time to put  in  the  graft  from  the  scrotum  to neovagina . the  hood  of critoris was  set  by  the  old  technique  the  labia minor  is not  securly  fixed. After 2 or  3 monthes  the  hood  and  groove of   labia was  not  well  defined. The labia  is   short  and  thick  to  maxumize  the  flap survival.

The spongy  tissue  was  reduced  but  after  long term  followup a large  mass still remained. Inside  the  vagina contain  a small  piece  of  graft . Almost  all consisted  of  penile  and scrotal flap.any  way  the distal of flap usuallt slough out and caused inadequate depth.

The 2nd edition

In  the 2^nd  edition we taper  the  flap  of  critoris  to  be  smaller. The result  of  the  hood  better  but  in some cases, the fixation  is loosen. We still had  the  problem of  circulation to critoris and  labia, so in the  case  of  longer labia  , some tissue  slough and  the  end  result is  not a well defined labia.

The 3^rd   technique

In the 3^rd edition the long  posterior flap (from scrotum) was created to make  a longer  vaginal  depth.During  this time because of improper cauterization machine, improper cauterization needle make the poor circulation  we cannot make  a long flap. After  that  we required verolap machine and tungstein-coated needle. During  this time we did not  use  the  new concept  of  packing and flap dissection, so  more flap survival make  the  better  depth and  width.