Autologous buccal mucosa graft augmentation for foreshortened vagina.
BACKGROUND
Vaginal foreshortening after pelvic surgery or radiotherapy may lead to dyspareunia and decreased quality of life. Unfortunately, little literature exists regarding treatment options for this debilitating problem. Autologous buccal mucosal grafting has been previously reported for creation of a total neovagina and the repair of postvaginoplasty vaginal stenosis.


METHODS
Autologous buccal mucosa offers several advantages as a replacement material for vaginal reconstruction. Vaginal and oral buccal mucosa are both hairless, moist, nonkeratinized stratified squamous epithelia. Buccal mucosa has a dense layer of elastic fibers, imparting both elasticity and strength, and acquires a robust neovascularity with excellent graft take. The graft material is readily available and donor site scars are hidden in the mouth.


RESULTS
A 60-year-old woman had vaginal foreshortening to 4.5 cm 15 years after radical hysterectomy and brachytherapy for endometrial cancer. She was unable to have intercourse despite attempted vaginal dilation. Her foreshortened vagina was successfully augmented with autologous buccal mucosa grafting at the apex, increasing her vaginal length to 8 cm and permitting pain-free intercourse.


CONCLUSIONS
Even in the face of an altered surgical field after radical hysterectomy and radiation, autologous buccal mucosa is an option for vaginal reconstruction for vaginal foreshortening.
Division of Pediatric Urology, Department of Urology, and the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and the Children's Medical Center, Dallas, Texas.
Gwen M
GM
Grimsby
Karen
K
Bradshaw
Linda A
LA
Baker
D004414:Dyspareunia / Q000209:etiology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000628:therapy*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D011878:Radiotherapy / Q000009:adverse effects; D014182:Transplantation, Autologous; D014621:Vagina / Q000473:pathology / Q000601:surgery*