| Objective:To evaluate the technical feasibility and anatomical and functional outcomes of one-stage vaginoplasty with autologous buccal micromucosa. Verify the shortcomings of the surgery and make the modification, then compare the efficacy of autologous buccal micromucosa only(ABMO) and that combined with acellular dermal matrix (ADM) in vaginoplasty.Methods:1. The patients who came to our hospital before October2010were assigned in the team of autologous buccal micromucosa only (ABMO). The patents came subsequently were told that the vaginoplasty could combine with or without ADM. The patients chose the surgery method and were assigned to the team of ABMO and ADM. Finally, there were38. in ABMO and17in ADM.2. The new vaginal cavity, appropriate to normal vaginal size (depth:9-12cm; diameter:3-4cm), was made with blunt dissection between the rectum and the bladder. In ABMO, the autologous buccal micromucosa was spread only, on the other hand, in ADM, the autologous buccal micromucosa was combined with the ADM together.3. Evaluate the morphology, histology, microenvironment and function of the neovaginal with long-term follow up.1,3,6,9, and12month post operation, the patients came back to the hospital, the epithelization was observed and functional results were assessed by using Rosen’s Female Sexual Function Index (FSFI) questionnaire, which is a validated test for the evaluation of female sexual quality. The circumference, length and volume of the neovagina were measured and recorded, and the data was compared to find if there was any statistical result.Results:1. In ABMO team, we found the neovaginal mucosa was stratified nonkeratinized squamous mucosa and had secretory function. The mean time for mucosal epithelialization to cover the entire neovaginal cavity was14.3±1.83days (range:12-19days). The mean depth of the neo vagina was8.53±0.66cm (range:7-10cm), the mean circumference was12.31±1.25cm (range:10-15cm) and the mean volume was100±8.16ml (range:85-120ml). The mean female sexual function index score of the32sexually active patients was28.8±2.12. No spouse reported discomfort during intercourse. The mean postoperative dependence on the vaginal stent was 15.26±2.1months (range:12-20months).2. In ADM team, we found the neovaginal had the same advantage with the ABMO team. The mean time for mucosal epithelialization to cover the entire neovaginal cavity was15.18±2.19days (range:12-20days). The mean depth of the neovagina was8.97±0.94cm (range:7-11cm), the mean circumference was12.32±1.35cm (range:10-14.5cm) and the mean volume was105±10ml (range:85-120ml). The mean female sexual function index score of the12sexually active patients was29.5±2.61. No spouse reported discomfort during intercourse. The mean postoperative dependence on the vaginal stent was11.7±1.64months (range:9-15months).3. The epithelialization of the cavity, the depth, the circumference, the volume of the neovagina and the female sexual function index score had no statistically significant result (p>0.05) in the two team.4. The postoperative dependence on the vaginal stent had statistically significant result (p<0.01) in the two team. The use of the ADM could reduce the dependence of the vaginal stent obviously.Conclusion:The vaginoplaty using autologous micromucosa has many advantages. At present, the disadvantage of the surgery is the long period of using dilator post operation. The modified surgery was executed wiith the ADM combined to autologous micromucosa. The time needed to use the dilator post operation is reduced obviously while the epithelization time does not be prolonged. There is no other significant difference of the anatomical and functional outcomes between the two teams. |
