Labioscrotal island flap in feminizing genitoplasty.
OBJECTIVE
Stenosis of the vaginal introitus is the most frequent complication after genital reconstruction for ambiguous genitalia associated with congenital adrenal hyperplasia (CAH). With the aim of enlarging the vaginal introitus, the authors present a technical modification of the introitoplasty that uses a bilateral cutaneous island flap based on the perineal superficial branches of the internal pudendal artery.


METHODS
Eleven girls with CAH and Prader III to V genital ambiguity were included. Feminizing genitoplasty was performed in 1 stage. Bilateral cutaneous labioescrotal island flaps, based on the posterior labial artery, were included in the introitoplasty. The cosmetic results of the genitoplasty were evaluated by photographic analysis of the external genitalia.


RESULTS
Integrity of the vaginal introitus as well as excellent integration of the flap and absence of additional scars in the donor area were assessed in all girls.


CONCLUSIONS
This modified island flap is technically feasible and reproducible producing no additional sequels in the donor area. It uses perineal skin that is usually excised in other techniques avoiding the use of harvesting skin from adjacent areas. Thus, it can be a useful additional procedure in the introitoplasty in association with the currently used techniques.
Miranda
Márcio Lopes
ML
Division of Pediatric Surgery and Pediatric Endocrinology, State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil.
Oliveira-Filho
Antônio Gonçalves de
AG
Lemos-Marini
Sofia Helena V
SH
Guerra
Gil
G
Bustorff-Silva
Joaquim Murray
JM
D000312:Adrenal Hyperplasia, Congenital / Q000601:surgery*; D047808:Adrenogenital Syndrome / Q000209:etiology / Q000601:surgery*; D002675:Child, Preschool; D002987:Clitoris / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D013524:Surgical Flaps; D016896:Treatment Outcome; D014621:Vagina / Q000002:abnormalities / Q000601:surgery*; D014844:Vulva / Q000601:surgery