Neovaginoplasty in congenitally absent vagina with bilateral pudendal thigh fasciocutaneous flaps

Background: Vaginal agenesis repair technique expensive and demanding in terms of expertise. Objective: To evaluate functional and aesthetic outcome of vaginal reconstruction using pudendal-thigh fasciocutaneous flaps. Methodology: Our case series was conducted at departments of plastic surgery and Obstetrics & Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan ST ST from 1 September 2012 to 31 August 2015. Vaginal reconstruction was done with bilateral island pudendal thigh flaps in 08 consecutive female patients with congenital absence of vagina. Each flap was raised just lateral to labia majora and then after passing under the labia majora both flaps were sutured together to form a neovaginal tube. This neovaginal tube was then inserted into a newly created space between the rectum and bladder. Results: Out of 8, three patients (37.5%) were diagnosed with Mayer Rokitansky Kauser Hauser Syndrome and 5 (62.5%) with isolated vaginal atresia. One patient (12.5%) developed necrosis of distal part of a unilateral flap followed by severe infection that was managed conservatively. The same patient also developed excessive hair growth in the neovagina. In rest of the seven patients all the flaps survived comletely and the neovaginal length and width was adequate. The mean vaginal length was 9.5 cm and width was 3.8 cm one year post operatively. Conclusion: Neovaginoplasty using bilateral islanded pudendal-thigh flaps is suggested as one of the best methods of vaginoplasty. This technique is very simple and reliable and has shown satisfactory functional and cosmetic results. The neovagina was sensate and has a natural angle for intercourse. No postoperative stenting or dilatation was required. The donor site was closed primarily and the resulting scar was in the groin crease with little secondary deformity.