Abstract
Objective
To address instances when there is insufficient remnant tissue to perform revision
following canal-deepening gender affirming vaginoplasty revisions as indicated by
insufficient depth. Options for lining of the vaginal canal include skin grafts, peritoneal
flaps, or intestinal segment. Our center uses robotically harvested peritoneal flaps
in vaginal canal revisions. When the peritoneal flap is insufficient for full canal
coverage, we use AlloDerm, an acellular dermal matrix, for additional coverage.
Methods
Retrospective analysis of 9 patients who underwent revision RPV with AlloDerm was
performed. Tubularized AlloDerm grafts were used to connect remnant vaginal lining
to the peritoneal flaps. Revision indications, surgical and patient outcomes, and
patient-reported post-op dilation were recorded.
Results
Nine patients underwent revision RPV using AlloDerm for canal deepening. Median follow-up
was 368 days (Range 186-550). Following revision, median depth and width at last follow-up
were 12.1 cm and 3.5 cm, and median increase in depth and width were 9.7 cm and 0.9
cm, respectively. There were no intraoperative complications. Two patients had focal
areas of excess AlloDerm that were treated with in-office excision without compromise
of the caliber or depth of the otherwise healed, epithelialized canal.
Conclusion
AlloDerm is an off-the-shelf option that does not require a secondary donor site.
The use of AlloDerm for a pilot cohort of patients lacking sufficient autologous tissue
for revision RPV alone was demonstrated to be safe and effective at a median 1-year
follow-up.
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Article info
Publication history
Published online: January 12, 2023
Accepted:
January 2,
2023
Received:
October 11,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Declaration of Interest: None.
Previously presented as a poster presentation at the World Professional Association for Transgender Health 27th Symposium on September 20, 2022.
Financial Disclosures: The authors declare that they have no relevant financial interests.
Identification
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