The 11th edition

MTF surgery the 11th   edition

The  development  of edition  11th  is to correct  the problem   in case  of  short penis and  it  is  the  development  from  the  9thedition . We can make  longer labial lip to  be more pimilar to  the  congenital labia.

The lining of vagina consisted of scrotal graft making  the anterior wall from the opening of valva  and  long scrotal flap a and graft to make  posterior wall. The  posterior  flap is  raised as parineal artery- pedicle flap , so  the  circulation to the  distal end  come from the 2 arteries from the groove of penile crus. As a result , the skin of the beginning of  posterior flaps can be cut medially to make  a space of  labia minor, then we can make  the  end  of labia come  closer  to be more similar to the female anatomy . Any way now  we cannot make  the true posterior fouchette because  of  the shortness  of  the tissue.

All of penile  skin  is  used  just for  the  labia minor reconstruction , the settit  of  upper half of labia  is the same  as the 9th edition but  for the  lower half, instead of hanging from the  anterior vaginal  wall, the labia attach  the side wall of  vagina  by 2 special designflap …from the posterior flap.

The developed pedicle posterior is  the  key to make the longer labial lip to  make  more esthitic vagina.

The 2nd version of  the 11st  edition

Since  there  is a lot  of change  happened in the  11st edition  so  a lot of  minor adjustment has been created.  At  the first time ,   we use a part of the posterior  flap to line  the  beginning of  anterior flap but since we donot  have a lot of tissue, the opening of  vagina is too  norrow  and  cause  the problem of  dilatiion. Then we use  the  scrotal graft more  to  the  beginning of  ant wall  but the result  of   graft contraction result  the  narrowing of  the  vg opening and pulling of  the urethal.

So now we modify  the  setting  of  the  urethal mocosa . the uretral tube is  separated in a new designed, getting  more tissue  to  the valva area and  less  tissue  to  the critoris  area. So  the  crus  of  critoris come closer  together to be  more natural and most mucosal  tissue move  to postrior  to  be the  beginning of  anterior vaginal wall. Since  the  tissue  is  a long flap, so  the   graft  contaction will  not  effect  the  urethal and  since  the  lining is mucosal tissue  that is  more similar to  female  vagina.the surface of  the  anterior wall  is   slipper and  natural, so  it  facilitate the sexual intecouse  and  dilation. The urethae flap can be  effectively used to   correct the problem of narrowingof valva.Moreover  at  the side of urethal flap, we can add the  urethral mucosal graft in the  new design that  can make  the  valva wider and  correct  the  problem of  inadequate  tissue at the anterior wall

This  setting  of urethrae is  not new. It   has been done  in europe for  more  than 20 years  but  indifferent  setting  from ours. The result is  excellent  for  functional vagina because  it make  the sexual  intercourse and dilation easier. Anyway some one  will  notice  the  redness  of  the urethrae  at  the  beginning of anterior  vaginal wall and  look  not esthetic. But  after  4 0r 5  monthes,  the  redness  will  turn to  be  pink color and  look  more  natural.

The risk  of  this  setting is  the separation of  the wound of labia minor if  the penis  is  too short an is  not easy  in the  setting for the primary colon vaginoplasty.





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