RESUMEN
INTRODUCTION: Persistent cloaca, defined as confluence of the rectum, the vagina and the urethra into a single common channel, has an estimated incidence of 1/50,000 live births. We describe the buccal mucosa graft vaginoplasty for a 11 year old female with cloaca, who underwent at the age of 11 months a Peña repair. We performed the vaginoplasty after the onset of uterine pain due to the beginning of menstruation. MATERIAL AND METHODS: We accessed the lower lip for superficial dissection to harvest the graft. The donor site has been kept with as much submucosal fat as possible to avoid damage to the buccinatoria muscles. A second graft was further obtained from the cheek. Both grafts were submitted to multiple small sections to produce a mesh graft and increase its size. A arciform incision anterior to the anal canal and posterior to the urethra was performed followed by consecutive dissection with eletrocautery to gain profundity. The mesh-graft was placed over the neovaginal cavity and sutured with 4.0 PDS monofilament suture used to suture and then quilt the graft in place. The vaginal capacity was confirmed by ease of a two-digit insertion. Haemostasis was confirmed before the insertion of a soft vaginal mold. The patient remained with an indwelling urinary catheter. The mold was equivalent to 24Fr and had 13 cm of profundity and Foley tube were removed after 14 days postoperatively. RESULTS: Patient had an excellent postoperative course and had been instructed to perform vaginal dilatation every 3 h during the day. Current follow up is 10 months. DISCUSSION: Buccal mucosal grafting has advantages over the use of keratinized skin flaps and intestinal flaps. Buccal mucosa is ideal for female genital reconstruction, given its color, texture, lack of hair and mild mucous production. In our particular case, we connected the neovagina after two months of adequate healing to the native 1/3 through laparoscopic approach. CONCLUSIONS: BMG vaginoplasty is a viable alternative to treat females with cloaca at adolescence.
Asunto(s)
Mucosa Bucal , Procedimientos de Cirugía Plástica , Adolescente , Humanos , Femenino , Lactante , Niño , Mucosa Bucal/trasplante , Vagina/cirugía , Colgajos Quirúrgicos/trasplante , Recto/cirugíaRESUMEN
Tissue engineering has provided new treatment alternatives for tissue reconstruction. Advances in the tissue engineering field have resulted in mechanical support and biological substitutes to restore, maintain or improve tissue/organs structures and functions. The application of tissue engineering technology in the vaginal reconstruction treatment can not only provide mechanical requirements, but also offer tissue repairing as an alternative to traditional approaches. In this review, we discuss recent advances in cell-based therapy in combination with scaffolds strategies that can potentially be adopted for gynaecological transplantation.
RESUMEN
OBJECTIVE: The total urogenital mobilization (TUM) technique avoids dissection of the vagina from the urinary tract. However, in the case of a long common channel, bowel interposition for vaginal replacement may be necessary. We present a video of the TUM technique in cloacal repair with ileal neovaginoplasty. METHODS: An 8-month-old female patient with cloaca, presenting a 4-cm common channel, was operated on by the TUM technique, through a perineal sagittal with additional abdominal approach. She had undergone decompressing colostomy at birth. Total urogenital sinus mobilization was performed with ileal neovaginoplasty. RESULTS: The patient had a good postoperative outcome, an endoscopy of all structures reconstructed was performed at PO day 30, and home dilatation of colon and vagina by parents was initiated. CONCLUSION: TUM with neovaginoplasty bowel interposition is an effective technique for repairing long common channels.