The 9th 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 9th 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.