This is done
We receive lots of patients who have been badly operated for SRS somewhere, in these cases penile and scrotal skin is found absent or very scanty. Such type of cases are managed with sigmoid colon vaginoplasty (Corrective/Salvage SRS).
For primary SRS cases (for small penis) External Genitalia is created as explained in “Creation of External Genitalia Section”
For Secondary (Redo or Corrective SRS) External Genitalia is corrected by repositioning (rearrangement) of leftover tissues.
After External Genitalia Creation, vaginal cavity is created between urethral bulb and rectum as explained in section of sigmoid colon steps in Combination Technique
Details of sigmoid colon graft harvesting for vaginoplasty
In ‘Sigmoid Colon only’ vaginoplasty, Sigmoid Colon graft is sutured with perineal skin and posterior scrotal skin flap.Owing to a long segment of colon, the vaginal opening may show red sigmoid colon patch.There is a theoretical possibility of long-term excessive secretions owing to this long segment. Though either primarily or as a secondary touch up the local perineal skin is utilised to give the vaginal opening normal appearance.
In Redo cases, meticulous intra-operative planning enables us to create Labia majora, Labia minora and Clitoris. Quite often the urethral opening is found at a higher position, in such cases urethra is repositioned at the desired level and part of urethral flap is utilised to create part of anterior vaginal wall.
In our practical experience, a normal vaginal opening can be achieved even in these cases either primarily or as a secondary touch up. The adjacent perineal penile and scrotal skin can be utilised judiciously in the form of rotation/ transposition flaps to construct a nearly natural vaginal opening concealing the Red Sigmoid Colon Graft.