title: Full-thickness skin mesh graft vaginoplasty: a skin sparing technique.
abstract: BACKGROUND
  The ideal vaginoplasty method should promote good cosmetic and functional results with low morbidity. We describe a new technique for congenital vaginal agenesis using a full-thickness perforated skin graft.
  
  
  METHODS
  We report an 18 year old patient with vaginal agenesis (Morris syndrome) that undergone a modified version of McIndoe vaginoplasty. Patient is set in a low lithotomy position and lateral traction sutures are placed in labia and a 16Fr urethral catheter inserted. An inverted "V"-shaped incision is made in the mucosal plaque below the urethra. Blunt dissection in a cephalic posterior direction forms a space between the rectum and urethra. Special care is taken to avoid rectal tear during this maneuver. A full-thickness skin graft is removed from the lower abdomen measuring 12.0x6.0cm as an aesthetic abdominoplasty. The fat tissue is removed, remaining epidermis and dermis and the graft is perforated, allowing a great surface increase. After suturing over a mold, the graft is fixed in the created space. The donor site is closed with intradermal transversal suture.
  
  
  RESULTS
  From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent this technique. There were no major complications or need for blood transfusions. At the six-month follow-up, all patients reported satisfactory sexual intercourse. There were no significant complications at donor site or neovagina that needed surgical intervention.
  
  
  CONCLUSIONS
  Vaginal reconstruction using the perforated graft is viable with excellent functional results. Applying this modification, we yielded the good results of a classic McIndoe technique with lower donor site morbidity.
authors.affiliation: Departamento de Urologia do Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil.
authors.forename: Guilherme Lang
authors.initials: GL
authors.lastname: Motta
authors.affiliation: Departamento de Urologia do Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil.
authors.forename: Patric Machado
authors.initials: PM
authors.lastname: Tavares
authors.affiliation: Departamento de Urologia do Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil.
authors.forename: Gabriel Veber Moisés
authors.initials: GVM
authors.lastname: Silva
authors.affiliation: Departamento de Urologia do Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil.
authors.forename: Milton
authors.initials: M
authors.lastname: Berger
authors.affiliation: Departamento de Urologia do Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil.
authors.forename: Brasil
authors.initials: B
authors.lastname: Silva
authors.affiliation: Departamento de Urologia do Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil.
authors.forename: Tiago Elias
authors.initials: TE
authors.lastname: Rosito
mesh_terms: D000293:Adolescent; D000013:Congenital Abnormalities / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D059351:Organ Sparing Treatments / Q000379:methods; D016038:Skin Transplantation / Q000379:methods*; D019738:Surgically-Created Structures; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery