Tuesday, January 28, 2014

Treatment of Vaginal Agenesis using the McIndoe Procedure (in English)

The treatment of vaginal agenesis

There are two options for the treatment of vaginal agenesis:
Nonsurgical – Vaginal dilators are used (and this is the first option in the majority of cases)
Surgical – The McIndoe technique is the surgical procedure most commonly used in present day.

The McIndoe technique

… consists of performing a careful dissection between the bladder and rectum, thus producing a cavity which will be formed by inserting a vaginal mold covered with a skin graft.

For this operation, a split-thickness skin graft is used.

To obtain a split-thickness skin graft, the superficial layer of the skin (epidermis) along with a part of the underlying tissue (dermis) is used. The donor site can be any area of the body, but in the majority of the cases it is an area that can be hidden with clothing, such as the buttocks or the interior thigh.

The dermatome

A dermatome is employed to obtain a split-thickness skin graft. The dermatome powered by air or electricity is preferred due to the uniformity and size of the graft produced with this instrument.

(we see in this slide) The donor site

Once the graft is taken, a compress containing petroleum jelly is applied to the donor site and covered with a bandage.

The vaginal mold

… is constructed using a foam rubber covered by a condom. The graft is applied with the outer (epidermal) layer next to the vaginal mold. The graft is folded over the mold and sutured with interrupted stitches of synthetic absorbable 4-0 suture.

Dissection of the vaginal canal

Dissection of the vaginal canal is begun with a curved incision of the mucosa of the vaginal introitus.

(following slide)

The dissection is continued following a cleavage plane between the bladder and rectum towards the peritoneum, being careful not to injure the bladder or rectum. A gentle blunt dissection is all that is necessary to create an adequate cavity.

(The mold is inserted into the cavity)

The mold covered with the skin graft is inserted into the cavity. A sagittal view of the pelvis shows the form inserted into the new vaginal canal.

(Maintaining the mold in place)

To maintain the mold in place, the labia majora are sutured in the midline with interrupted sutures of 0-nylon without tension. The sutures are cut and the form removed for cleaning after 7 days.

Postoperative treatment

Initially, the patient keeps the mold in place during the day and night. After four weeks, she can attempt sexual intercourse. The patient continues to use the mold at night for about three months.

No comments: