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jedna sretna mama
Dragi doktore,hvala Vam jer ste prije svega veliki čovjek i veliki liječnik,hvala vam jer ste nam
Bryson
There’s a trerific amount of knowledge in this article!
METOIDIOPLASTY - SURGICAL TECHNIQUE (one stage) PDF Print E-mail


PREOPERATIVE APPEARANCE

   Appearance of the external female genitalia before surgery. Clitoris is enlarged using topical dihydrotestosterone combined with vacuum device.

   Marked lines show incisions. Urethral plate, mucosal part from urethral opening and glans cap, is marked to be wide. Labia minora are marked for labial skin flaps use.






CLITORAL LENGTHENING

   All clitoral ligaments should be divided to lengthen clitoris. These ligaments are very well developed and make hooded clitoris in normal female. Division should be radical and includes lateral and suspensory ligaments.

   Urehral plate is too short and causes ventral curvature. Plate is mobilized together with spongiosal tissue before cutting to prevent extreme bleeding.

   Appearance after division of ligaments dorsolaterally and short urethral plate ventrally. Clitoris is completely lengthened. Marked places on the dorsum show levels of ligament attachments.

   Ventral aspect after division of the urethral plate. Gap between glans cap and urethral opening is 6 cm long. Bleeding is minimal thanks to very precise dissection of
                                                                                                                                                                     spongiosal tissue.


URETHRAL RECONSTRUCTION - bulbar part

   Reconstruction of the bulbar urethra. Well-vascularized vaginal flap is created from anterior vaginal wall.

   Vaginal flap and urethral plate are joined to form bulbar urethral part. This way, urethra is lengthened.







URETHRAL RECONSTRUCTION - buccal mucosa graft

   Buccal mucosa graft is placed to cover the gap between glans cap and bulbar urethra.

   Appearance of the donor site after harvesting the graft and closure the defect.

   Buccal graft is fixed to the corporal bodies by quilting sutures. It is very important to prevent haematoma formations and for better survival of the graft.






URETHRAL RECONSTRUCTION - clitoral skin flap

   Very long skin flap is harvested from the dorsal clitoral skin. Flap is harvested with very wide subcutaneous vascularized tissue.

   Flap is transposed ventrally by button-hole maneuver and prepared to join with buccal mucosa graft.

   Joining of the skin flap and buccal mucosa graft. Glans is also opened for creation of glandial part of the urethra.

   Urethral reconstruction is done. All suture lines are covered with vascularized tissue. It is very important in prevention of fistula formation.




URETHRAL RECONSTRUCTION - labia minora flap

   Flap from inner labial surface is designed in appropriate size.

   Flap is dissected from the border between inner and outer labial surface. It is attached to the base for better blood supply support. One edge is joined with dorsal part of urethra formed from buccal mucosa graft

   Urethra is formed. Suture lines will be covered with outer surface of the labia minora that will be ventral part of the penile skin.






SCROTOPLASTY/TESTICULAR IMPLANTS

   Reconstruction of the penile skin is done. Scrotum is formed by joining of both labia majora. Perineum is created to be as a male.

   Testicle implants are inserted into the scrotum using two similar incisions at the top of the scrotum.








FINAL ASPECTS



   Appearance after surgery. Penis is positioned at right position. Very well relationship between penis and scrotum is achieved.

 

 

 

 

RESULTS

   Outcome three months later.

   Voiding in standing position.

   Three years after metoidioplasty