Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?

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Abstract

Background: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-Thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Methods: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-Thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. Results: A total of 100 patients were included (32 with and 68 without additional full-Thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). Conclusions: The authors can confirm neither of the suggested arguments, for or against full-Thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-Thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient-And physician-reported aesthetic or functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Original languageEnglish
Pages (from-to)649e-656e
JournalPlastic and reconstructive surgery
Volume139
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

Cite this

@article{23002d1b12b14ac0a6f91e8f3dff1e21,
title = "Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?",
abstract = "Background: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-Thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Methods: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-Thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. Results: A total of 100 patients were included (32 with and 68 without additional full-Thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). Conclusions: The authors can confirm neither of the suggested arguments, for or against full-Thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-Thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient-And physician-reported aesthetic or functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.",
author = "Buncamper, {Marlon E.} and {Van Der Sluis}, {Wouter B.} and {De Vries}, Max and Witte, {Birgit I.} and Bouman, {Mark Bram} and Mullender, {Margriet G.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1097/PRS.0000000000003108",
language = "English",
volume = "139",
pages = "649e--656e",
journal = "Plastic and reconstructive surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft

T2 - To Graft or Not to Graft?

AU - Buncamper, Marlon E.

AU - Van Der Sluis, Wouter B.

AU - De Vries, Max

AU - Witte, Birgit I.

AU - Bouman, Mark Bram

AU - Mullender, Margriet G.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-Thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Methods: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-Thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. Results: A total of 100 patients were included (32 with and 68 without additional full-Thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). Conclusions: The authors can confirm neither of the suggested arguments, for or against full-Thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-Thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient-And physician-reported aesthetic or functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

AB - Background: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-Thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Methods: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-Thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. Results: A total of 100 patients were included (32 with and 68 without additional full-Thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). Conclusions: The authors can confirm neither of the suggested arguments, for or against full-Thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-Thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient-And physician-reported aesthetic or functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

UR - http://www.scopus.com/inward/record.url?scp=85014097127&partnerID=8YFLogxK

U2 - 10.1097/PRS.0000000000003108

DO - 10.1097/PRS.0000000000003108

M3 - Article

VL - 139

SP - 649e-656e

JO - Plastic and reconstructive surgery

JF - Plastic and reconstructive surgery

SN - 0032-1052

IS - 3

ER -