The edition 14th
There are some problems in the patients who have a small penis or ones who have circumcised is the lack of prepuce skin to make a good shape of labia minora. In this group the labias will be short in length and width ; most of the time, they seldom cover the vaginal opening. Even they can cover the opening , because the shortness of tissue to make the inner labia , sometime they cause narrowing of the introitus and cause difficulty during dilatation and sexual intercourse.
The 14th edition will be an option to make the labia minor in ones who are circumcised or have short penis in the minor degree. The outside labia is made by skin from penile shaft ,and the inner side is make from 3 sorts of tissue; the upper part is prepuce that will be very short but can connect the clitoris with the lower tissue, the lower part is the remnant of lower part of penis designed as reverse flap, the middle part is covered with the graft from scrotal skin or urethral mucosa. The urethral graft will be red for 3 to 4 months; then it will be pale and pink and look more natural. The benefit of urethral mucosa is self-lubrication that will facilitate sexual intercourse but take a long time to look natural and, because in the small penis , the urethral mucosa will be short too, in some case the graft will not be enough to make the good result. The scrotal graft is another option in some case that more extra scrotal skin can be harvested or some grafts that plan to make the vagina can be shared. For this technic, the labia is not self-lubricated , but the scrotal graft can be taken bigger and longer ,so we can get the wide and long skin graft enough to cover the large gap between the upper and the lower part of the inner labias. The benefit of the scrotal interpose graft is more tissue to fill the gap that can make a longer and wider labia but still very thin in order to facilitate sexual intercourse and dilation and get the good feature of the labias. It will take 2 or 3 months to be completely heal and look more natural.
Because the technic is the basic of graft technic, the labia will be thin and look more esthetic ; compare to the technic of scrotal flap in the edition 15. Since the outer flap have to be very well vascularized to feed the graft that we put in, it need a good delicate surgical skill to raise the penile flap because if the penile flap is not survived, the graft will not survived too ;that will make the flap and graft slough and turn to be short labias. Anyway, this is an inventional technic and the only technic nowadays that graft can be used for the labias to make them very thin and long to complete the concept of the beautiful labias.
In this edition we will call the labia interposition with urethral graft as 14a,with scrotal graft as 14b