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.