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Vaginal & genitourinary reconstruction

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Vaginal & Genitourinary Reconstruction Sanjay Sharma, M.D. Jeffrey Friedman, M.D. Rahul Nath, M.D. Tue Dinh, M.D.
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy/Embryology
Anatomy/Embryology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy/Embryology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy/Embryology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
External Genitalia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Congenital Defects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ambiguous Genitalia
Bladder Exstrophy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Bladder Exstrophy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rokitansky Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rokitansky Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Preoperative Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Frank Method ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bowel Flaps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Local Flaps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
McIndoe Technique ,[object Object],[object Object],[object Object],[object Object],[object Object]
McIndoe Procedure
McIndoe Technique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Procedure ,[object Object],[object Object],[object Object],[object Object],[object Object]
STSG Donor Sites Tumescence for uniform Surface skin graft
Procedure ,[object Object],[object Object],[object Object],[object Object],[object Object]
Procedure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Graft Fixation , dermal side out
[object Object]
 
Avoid straight line incisions at introitus
 
Rectovesical Space Peritoneal reflection (15 cm)
Meticulous hemostasis is essential
 
 
Suture labia together, prevents extrusion
 
Procedure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Check graft at POD #7 Regraft if >2 cm necrosis
Post-operative care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acquired Defects of GU System
Acquired Defects of GU System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Preoperative Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assessment of Defect ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vulvoperineal Surface ,[object Object],[object Object],[object Object],[object Object]
Vulvoperineal Surface ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Vulvoperineal Surface ,[object Object],[object Object]
Vulvoperineal Surface ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],8X15 cm skin island
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object]
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
 
 
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Vault Posterior Thigh Flap
Vaginal Vault Reconstuction
Vaginal Vault Reconstuction
Vaginal Vault Reconstuction
Vaginal Vault Reconstuction
Vaginal Vault Reconstuction
Vaginal Vault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Penis and Scrotum
Penile-Scrotal Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Penile-Scrotal Defects ,[object Object],[object Object],[object Object],[object Object],[object Object]
Avulsions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Scrotal avulsions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scrotal avulsions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scrotal Defects
Scrotal Defects
Scrotal Defect Gracilis myocutaneous flap
Scrotal Defect
Coverage with Gracilis
Algorithm ,[object Object],[object Object],[object Object],[object Object],[object Object]
Algorithm ,[object Object],[object Object],[object Object],[object Object]
Penis Amputations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Amputations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Penis Replantation
Penis Replantation
Penis Replantation
 
 
Penis Replantation
Penis Reconstruction
Penile Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Phallus Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Penile Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radial Forearm Flap
Radial Forearm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Radial Forearm ,[object Object],[object Object]
Radial Forearm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Penile Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Phallus Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Gender Reassignment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Male Potency ,[object Object],[object Object],[object Object],[object Object]
Cavernous Nerve Grafting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Unilateral Cavernous Nerve resection with Sural Nerve graft
Nerve graft Silastic tubing Metal clip microsuture Melted end of suture Cavernous nerve repair with Sural nerve grafts Nerve graft
Results 0% 60% Bilateral nerve grafts 21% 75% Unilateral nerve grafts Percentage of successful inter-course WITHOUT nerve grafting Percentage of successful inter-course WITH nerve grafting 200 cases to date
Inguinal Region ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inguinal Region ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vascular Graft Coverage
Gracilis Rotation Coverage
Gracilis Rotation Flap
Sartorius Flap
Exposed Vascular Graft
Sartorius Rotation Coverage
Infections ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fournier’ Gangrene ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Genital Burns ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pelvic Exenteration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pelvic Exenteration ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pelvic/Perineum Defect
VRAM Reconstruction
VRAM to Pelvic Defect
Pelvic Defects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pelvic/Perineal Defects
 
Pelvic/Perineal Defects
Final Result
Anal Sphincter Reconstruction ,[object Object],[object Object],[object Object],[object Object]
Gracilis Sphincter Reconstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THANKS TO: Jeff Friedman, M.D. Rahul Nath, M.D Tue Dinh, M.D.

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