Browse > Article

A Modified McIndoe Operation for Treatment of Vaginal Agenesis  

Tark, Kwan Chul (Institue for Human Tissue Restoration, & Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
Choi, Bong Kyoon (Institue for Human Tissue Restoration, & Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
Choi, Jong Woo (Institue for Human Tissue Restoration, & Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
Publication Information
Archives of Plastic Surgery / v.32, no.1, 2005 , pp. 117-123 More about this Journal
Abstract
The reconstructive modalities for vaginal reconstruction include simple dilatation, skin graft, use of intestinal segments and various methods using flaps. However, skin grafting procedure is the most commonly used technique and the McIndoe procedure is a representative technique among skin grafting procedures. McIndoe procedure is easier, faster and has a lower morbidity compared to other techniques. However the conventional McIndoe procedure has several problems such as incomplete vestibule formation, excessive bleeding during dissection, possibility of recto-vaginal or urethro-vaginal fistula formation, late vaginal contracture and discomfort in wearing hard plastic mold for a long time after operation. To solve these problems, the authors modified the conventional McIndoe procedure in several perspectives. The undeveloped vestibule was incised with X-shaped mucosal incision between the urethral opening and posterior margin of the vestibule and deepened by blunt finger dissection to provide a sufficient diameter & length of the neovagina and to minimize bleeding. A sizable medium thickness split skin graft was harvested and wrapped over a roll gauze-filled condom mold. Applying multiple stab incision on the skin grafted condom mold, it was inserted into the prepared neovaginal canal. Distal margin of the skin graft was secured with tips of the mucosal flaps created by X-shaped vestibular incision to prevent accidental extrusion of the skin grafted mold. During last 15 years, we applied this modification to 20 vaginal agenesis patients and investigated results of the 12 patients who could be followed up serially including hematoma formation and skin graft survival rate, size, depth, presence of late contracture, appearance, comfortness, and hygiene of the neovagina. And they were compared with 8 patients of 20 patients who underwent conventional McIndoe procedures. The modified McIndoe procedure revealed lower complication rate, higher patient satisfaction and better functional results.
Keywords
Modified Mclndoe procedure; Vaginal agenesis;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Seccia A, Salgarello M, Sturla M, Loreti A, Latorre S, Farallo E: Neovaginal reconstruction with the modified Mcindoe technique: A review of 32 cases. Ann Plast Surg 49: 379, 2002   DOI   ScienceOn
2 Min KW, Park YJ: Experiences in treatment using modified Abbe-Mcindoe technique for congenital cervical hypoplasia combined with vaginal agenesis. J Korean Soc Plast Reconstr Surg 23: 1427, 1996
3 Zahid BM, Kogan S, Petro J, Kutty M, Chuang L: Vaginal reconstruction with a rectus abdominis musculoperitoneal flap. Ann Plast Surg 46: 563, 2001   DOI   ScienceOn
4 Wee JTK, Joseph VT: A new technique of vaginal reconstruction using neurovascular pudendal thigh flap: A preliminary report. Plast Reconstr Surg 83: 701, 1989   DOI   ScienceOn
5 Adamson CD, Naik BJ, Lynch DJ: The vacuum expandable condom mold: a simple vaginal stent for Mclndoestyle vaginoplasty. Plast Reconstr Surg 113: 664, 2004   DOI   ScienceOn
6 Kim SK, Jung YH: Reconstruction of the female genitalia. J Korean Soc Plast Reconstr Surg 23: 804, 1996
7 Folch M, Pigem I, Konje JC: Mullerian agenesis: Etiology, diagnosis and management. Obstetrical and Gynecological Survey 55: 644, 2000   DOI   ScienceOn
8 Monstrey S, Matton G: The versatility of the pudendal thigh fasciocutaneous flap used as an island flap. Plast Reconstr Surg 107: 719, 2001   DOI   ScienceOn
9 Carla PR, Michael JH, John AR: Vaginal creation for Mullerian agenesis. Obstetrical and Gynecological Survey 57: 212, 2002   DOI   ScienceOn
10 Casey WJ, Woods JE: A comparison of 99 consecutive vaginal reconstructions: an outcome study. Ann Plast Surg 52: 27, 2004   DOI   ScienceOn
11 Tercan M, Balat O, Bekerecioglu M, Atik B: The use of fibrin glue in the McIndoe technique of vaginoplasty. Plast Reconstr Surg 109: 706, 2002   DOI   ScienceOn
12 Ninkovic M, Dabernig W: Flap technology for reconstructions of urogenital organs. Current Opinion in Urology 13: 483, 2003   DOI   ScienceOn