For some patients who have very small penis or ones who have circumcised by the technic of high level circumcision may have a severe shortness of prepuce skin that is not enough to make a good shape of labia minors. In this group the labia will be short and narrow ; most of the time, they cannot 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.
In order to correct that problem, in some case that we do not use the scrotal skin such as primary colon vaginoplasty or in case that the scrotal skin is very long or in case that the patient decides to use skin graft from the groin crease or lower abdomen for making the deeper neovagina, the scrotal skin flap can be designed to be the outer layer and the lower part of inner side of labia minors that we call posterior forchette. For this 15th edition, the whole outer side is totally made by the scrotal skin, while the inner layer is divide into 3 parts; the upper part by the small remnant of prepuce, the middle by the small penile shaft ( design as turnover flap)and the lower part by the excess tissue of the scrotum. Because this is the technic of flap for reconstruction, the final outcome of the labias will be a little bit too thick and too wide at the beginning. Even they will be smaller in 2 or 3 months, in some cases, they might need a later revision to make them smaller and flat after 6 months.