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Aesthetic Plast Surg. 2018 Apr;42(2):491-497. doi: 10.1007/s00266-018-1088-z. Epub 2018 Jan 30.

Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-vagina in Male-to-Female Reassignment Surgery.

Author information

1
Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran.
2
Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran. hamidkarimi1381@yahoo.com.
3
Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Abstract

BACKGROUND:

Plastic surgeons have used several methods for the construction of neo-vaginas, including the utilization of penile skin, free skin grafts, small bowel or recto-sigmoid grafts, an amnion graft, and cultured cells.

PURPOSE:

The aim of this study is to compare the results of amnion grafts with amnion seeded with autograft fibroblasts.

MATERIALS AND METHODS:

Over 8 years, we compared the results of 24 male-to-female transsexual patients retrospectively based on their complications and levels of satisfaction. Sixteen patients in group A received amnion grafts with fibroblasts, and the patients in group B received only amnion grafts without any additional cellular lining. The depths, sizes, secretions, and sensations of the vaginas were evaluated. The patients were monitored for any complications, including over-secretion, stenosis, stricture, fistula formation, infection, and bleeding.

RESULTS:

The mean age of group A was 28 ± 4 years and group B was 32 ± 3 years. Patients were followed up from 30 months to 8 years, (mean 36 ± 4) after surgery. The depth of the vaginas for group A was 14-16 and 13-16 cm for group B. There was no stenosis in neither group. The diameter of the vaginal opening was 34-38 mm in group A and 33-38 cm in group B. We only had two cases of stricture in the neo-vagina in group B, but no stricture was recorded for group A. All of the patients had good and acceptable sensation in the neo-vagina. Seventy-five percent of patients had sexual experience and of those, 93.7% in group A and 87.5% in group B expressed satisfaction.

CONCLUSION:

The creation of a neo-vaginal canal and its lining with allograft amnion and seeded autologous fibroblasts is an effective method for imitating a normal vagina. The size of neo-vagina, secretion, sensation, and orgasm was good and proper. More than 93.7% of patients had satisfaction with sexual intercourse. Amnion seeded with fibroblasts extracted from the patient's own cells will result in a vagina with the proper size and moisture that can eliminate the need for long-term dilatation. The constructed vagina has a two-layer structure and is much more resistant to trauma and laceration. No cases of stenosis or stricture were recorded.

LEVEL OF EVIDENCE IV:

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

KEYWORDS:

Gender reassignment surgery; Orgasm; Satisfaction; Transgender surgery; Transsexual; Vaginoplasty

PMID:
29383415
DOI:
10.1007/s00266-018-1088-z

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