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Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-vagina in Male-to-Female Reassignment Surgery

  • Original Article
  • Genital Surgery
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Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Plastic surgeons have used several methods for the construction of neo-vaginas, including the utilization of penile skin, free skin grafts, small bowel or recto-sigmoid grafts, an amnion graft, and cultured cells.

Purpose

The aim of this study is to compare the results of amnion grafts with amnion seeded with autograft fibroblasts.

Materials and Methods

Over 8 years, we compared the results of 24 male-to-female transsexual patients retrospectively based on their complications and levels of satisfaction. Sixteen patients in group A received amnion grafts with fibroblasts, and the patients in group B received only amnion grafts without any additional cellular lining. The depths, sizes, secretions, and sensations of the vaginas were evaluated. The patients were monitored for any complications, including over-secretion, stenosis, stricture, fistula formation, infection, and bleeding.

Results

The mean age of group A was 28 ± 4 years and group B was 32 ± 3 years. Patients were followed up from 30 months to 8 years, (mean 36 ± 4) after surgery. The depth of the vaginas for group A was 14–16 and 13–16 cm for group B. There was no stenosis in neither group. The diameter of the vaginal opening was 34–38 mm in group A and 33–38 cm in group B. We only had two cases of stricture in the neo-vagina in group B, but no stricture was recorded for group A. All of the patients had good and acceptable sensation in the neo-vagina. Seventy-five percent of patients had sexual experience and of those, 93.7% in group A and 87.5% in group B expressed satisfaction.

Conclusion

The creation of a neo-vaginal canal and its lining with allograft amnion and seeded autologous fibroblasts is an effective method for imitating a normal vagina. The size of neo-vagina, secretion, sensation, and orgasm was good and proper. More than 93.7% of patients had satisfaction with sexual intercourse. Amnion seeded with fibroblasts extracted from the patient’s own cells will result in a vagina with the proper size and moisture that can eliminate the need for long-term dilatation. The constructed vagina has a two-layer structure and is much more resistant to trauma and laceration. No cases of stenosis or stricture were recorded.

Level of Evidence IV

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References

  1. Aydin D, Buk LJ, Partoft S, Bonde C, Thomsen MV, Tos T (2016) Transgender surgery in Denmark from 1994 to 2015: 20-year follow-up study. J Sex Med 13(4):720–725

    Article  PubMed  Google Scholar 

  2. Fugate SR, Apodaca CC, Hibbert ML (2001) Gender reassignment surgery and the gynecological patient(1). Prim Care Update Ob Gyns 8(1):22–24

    Article  PubMed  Google Scholar 

  3. Abdian N, Ghasemi-Dehkordi P, Hashemzadeh-Chaleshtori M, Ganji-Arjenaki M, Doosti A, Amiri B (2015) Comparison of human dermal fibroblasts (HDFs) growth rate in culture media supplemented with or without basic fibroblast growth factor (bFGF). Cell Tissue Bank 16(4):487–495

    Article  CAS  PubMed  Google Scholar 

  4. Rubin SO (1993) Sex-reassignment surgery male-to-female. Review, own results and report of a new technique using the glans penis as a pseudoclitoris. Scand J Urol Nephrol Suppl 154:1–28

    CAS  PubMed  Google Scholar 

  5. Wangjiraniran B(1), Selvaggi G, Chokrungvaranont P, Jindarak S, Khobunsongserm S, Tiewtranon P (2015) Male-to-female vaginoplasty: Preecha’s surgical technique. J Plast Surg Hand Surg 49(3):153–159. https://doi.org/10.3109/2000656x.2014.967253

  6. Colebunders B(1), Brondeel S(1), D’Arpa S(1), Hoebeke P(2), Monstrey S(3) (2017) An update on the surgical treatment for transgender patients. Sex Med Rev 5(1):103–109. https://doi.org/10.1016/j.sxmr.2016.08.001

  7. Li Y, Liu F, Zhang Z, Zhang M, Cao S, Li Y, Zhang L, Huang X, Xu Y (2015) Bone marrow mesenchymal stem cells could acquire the phenotypes of epithelial cells and accelerate vaginal reconstruction combined with small intestinal submucosa. Cell Biol Int 39(11):1225–1233

    Article  CAS  PubMed  Google Scholar 

  8. Filipas D (2001) Vaginal reconstruction/fistulae. Curr Opin Urol 11(3):267–270

    Article  CAS  PubMed  Google Scholar 

  9. Grünberger V, Behawetz J (1975) Wertheim’s radical operation with vaginal reconstruction by means of the sigmoid colon in young women (author’s transl)]. Wien Klin Wochenschr 87(20):671–674

    PubMed  Google Scholar 

  10. Dessy LA(1), Mazzocchi M, Corrias F, Ceccarelli S, Marchese C, Scuderi N (2014) The use of cultured autologous oral epithelial cells for vaginoplasty in male-to-female transsexuals: a feasibility, safety, and advantageousness clinical pilot study. Plast Reconstr Surg 133(1):158–161. https://doi.org/10.1097/01.prs.0000435844.95551.35

  11. Kwun Kim S, Hoon Park J, Cheol Lee K, Min Park J, Tae Kim J, Chan Kim M (2003) Long-term results in patients after rectosigmoid vaginoplasty. Plast Reconstr Surg 112(1):143–151

    Article  PubMed  Google Scholar 

  12. Hensle TW, Reiley EA (1998) Vaginal reconstruction in girls and young adults. Arch Esp Urol 51(6):527–536

    CAS  PubMed  Google Scholar 

  13. Wroblewski P, Gustafsson J, Selvaggi G (2013) Sex reassignment surgery for transsexuals. Curr Opin Endocrinol Diabetes Obes 20(6):570–574

    Article  PubMed  Google Scholar 

  14. Selvaggi G, Ceulemans P, De Cuypere G, VanLanduyt K, Blondeel P, Hamdi M, Bowman C, Monstrey S (2005) Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals. Plast Reconstr Surg. 116(6):135e–145e

    Article  PubMed  Google Scholar 

  15. Hage JJ, Karim RB (1998) Abdominoplastic secondary full-thickness skin graft vaginoplasty for male-to-female transsexuals. Plast Reconstr Surg 101(6):1512–1515

    Article  CAS  PubMed  Google Scholar 

  16. Dreher PC, Edwards D, Hager S, Dennis M, Belkoff A, Mora J, Tarry S, Rumer KL (2017) Complications of the neo-vagina in male-to-female transgender surgery: a systematic review and meta-analysis with discussion of management. Clin Anat. https://doi.org/10.1002/ca.23001

  17. Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG (2015) Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med 12(6):1499–1512. https://doi.org/10.1111/jsm.12868

    Article  PubMed  Google Scholar 

  18. Karim RB, Hage JJ, Bouman FG, de Ruyter R, van Kesteren PJ (1995) Refinements of pre-, intra-, and postoperative care to prevent complications of vaginoplasty in male transsexuals. Ann Plast Surg 35(3):279–284

    Article  CAS  PubMed  Google Scholar 

  19. Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG (2015) Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. J Sex Med 12(7):1626–1634

    Article  PubMed  Google Scholar 

  20. Liguori G, Trombetta C, Buttazzi L, Belgrano E (2001) Acute peritonitis due to introital stenosis and perforation of a bowel neo-vagina in a transsexual. Obstet Gynecol 97(5 Pt 2):828–829

    CAS  PubMed  Google Scholar 

  21. Raigosa M(1), Avvedimento S(1), Yoon TS(1), Cruz-Gimeno J(1), Rodriguez G(1), Fontdevila J(1) (2015) Male-to-female genital reassignment surgery: a retrospective review of surgical technique and complications in 60 patients. J Sex Med 12(8):1837–1845. https://doi.org/10.1111/jsm.12936

  22. Haustein UF (1995) Pruritus of the artificial vagina of a transsexual patient caused by gonococcal infection. Hautarzt 46(12):858–859

    Article  CAS  PubMed  Google Scholar 

  23. Revol M, Servant JM, Banzet P (2006) Surgical treatment of male-to-female transsexuals: a ten-year experience assessment. Ann Chir Plast Esthet 51(6):499–511

    Article  CAS  PubMed  Google Scholar 

  24. Hyde SE, Hacker NF (1999) Vaginal reconstruction in the fibrotic pelvis. Aust N Z J Obstet Gynaecol 39(4):448–453

    Article  CAS  PubMed  Google Scholar 

  25. Hensle TW, Seaman EK (1995) Vaginal reconstruction in children and adults. Tech Urol 1(4):174–180

    CAS  PubMed  Google Scholar 

  26. Karjalainen O, Myllynen L, Kajanoja P, Tenhunen A, Purola E, Timonen S (1980) Management of vaginal agenesis. Ann Chir Gynaecol 69(1):37–41

    CAS  PubMed  Google Scholar 

  27. Small MP (1987) Penile and scrotal inversion vaginoplasty for male to female transsexuals. Urology 29(6):593–597

    Article  CAS  PubMed  Google Scholar 

  28. Dong L (2006) Comparison study between two types of vaginoplasty. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 20(8):829–831

    PubMed  Google Scholar 

  29. Ichihara K, Masumori N (2016) Sex reassignment surgery with laparoscopic sigmoid colon vaginoplasty in a male to female transsexual: a case report. Nihon Hinyokika Gakkai Zasshi 107(2):126–128

    PubMed  Google Scholar 

  30. Karim RB, Hage JJ, Cuesta MA (1996) Rectosigmoid neocolpopoiesis for male-to-female transsexuals: Amsterdam experience. Ann Plast Surg 36(4):388–391

    Article  CAS  PubMed  Google Scholar 

  31. Shimamura Y, Fujikawa A, Kubota K, Ishii N, Fujita Y, Ohta K (2015) Perforation of the neo-vagina in a male-to-female transsexual: a case report. J Med Case Rep 23(9):24

    Article  Google Scholar 

  32. Chatterjee SR (2003) Two case reports on vaginoplasty in cases of congenital absence of vagina. J Indian Med Assoc 101(10):606–607

    CAS  PubMed  Google Scholar 

  33. Mhaskar R (2005) Amniotic membrane for cervical reconstruction. Int J Gynaecol Obstet 90(2):123–127

    Article  CAS  PubMed  Google Scholar 

  34. Ghanbari Z, Dahaghin M, Borna S (2006) Long-term outcomes of vaginal reconstruction with and without amnion grafts. Int J Gynaecol Obstet 92(2):163–164

    Article  CAS  PubMed  Google Scholar 

  35. Sarwar I, Sultana R, Nisa RU, Qayyum I (2010) Vaginoplasty by using amnion graft in patients of vaginal agenesis associated with Mayor-Rokitansky-Kuster-Hauser syndrome. J Ayub Med Coll Abbottabad. 22(1):7–10

    PubMed  Google Scholar 

  36. Huang L, Ye M, Wang YB, Ji B, Tang JL (2009) Analysis of 81 cases of congenital anomalies of the vagina. Nan Fang Yi Ke Da Xue Xue Bao. 29(7):1468–1470

    PubMed  Google Scholar 

  37. Fotopoulou C, Sehouli J, Gehrmann N, Schoenborn I, Lichtenegger W (2010) Functional and anatomic results of amnion vaginoplasty in young women with Mayer-Rokitansky-Küster-Hauser syndrome. Fertil Steril 94(1):317–323

    Article  PubMed  Google Scholar 

  38. Zafar M, Saeed S, Kant B, Murtaza B, Dar MF, Khan NA (2007) Use of amnion in vaginoplasty for vaginal atresia. J Coll Physicians Surg Pak 17(2):107–109

    PubMed  Google Scholar 

  39. Tolhurst DE, van der Helm TW (1991) The treatment of vaginal atresia. Surg Gynecol Obstet 172(5):407–414

    CAS  PubMed  Google Scholar 

  40. Toshev G (1964) Plastic surgical technics in the treatment of vaginal malformations with the use of preserved amnion. Akush Ginekol (Sofiia) 3:123–128

    CAS  Google Scholar 

  41. Jarrar K, Wolff E, Weidner W (1996) Long-term outcome of sex reassignment of male transsexual patients. Urologe A 35(4):331–337

    CAS  PubMed  Google Scholar 

  42. Lobato MI, Koff WJ, Manenti C, da Fonseca Seger D, Salvador J, da Graça Borges Fortes M, Petry AR, Silveira E, Henriques AA (2006) Follow-up of sex reassignment surgery in transsexuals: a Brazilian cohort. Arch Sex Behav 35(6):711–715

    Article  PubMed  Google Scholar 

  43. Sigurjónsson H, Möllermark C, Rinder J, Farnebo F, Lundgren TK (2017) Long-term sensitivity and patient-reported functionality of the neoclitoris after gender reassignment surgery. J Sex Med 14(2):269–273

    Article  PubMed  Google Scholar 

  44. Stein M, Tiefer L, Melman A (1990) Followup observations of operated male-to-female transsexuals. J Urol 143(6):1188–1192

    Article  CAS  PubMed  Google Scholar 

  45. Blanchard R, Legault S, Lindsay WR (1987) Vaginoplasty outcome in male-to-female transsexuals. J Sex Marital Ther 13(4):265–275

    Article  CAS  PubMed  Google Scholar 

  46. Fang RH, Chen TJ, Chen TH (2003) Anatomic study of vaginal width in male-to-female transsexual surgery. Plast Reconstr Surg 112(2):511–514

    Article  PubMed  Google Scholar 

  47. Hage JJ, Goedkoop AY, Karim RB, Kanhai RC (2000) Secondary corrections of the vulva in male-to-female transsexuals. Plast Reconstr Surg 106(2):350–359

    Article  CAS  PubMed  Google Scholar 

  48. Fernandes HM, Manolitsas TP, Jobling TW (2014) Carcinoma of the neo-vagina after male-to-female reassignment. J Low Genit Tract Dis 18(2):E43–E45

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors have no financial disclosure related to this article.

Author information

Authors and Affiliations

  1. Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran

    Kamal Seyed-Forootan & Hamid Karimi

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Nazilla-Sadat Seyed-Forootan

Authors
  1. Kamal Seyed-Forootan
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  2. Hamid Karimi
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  3. Nazilla-Sadat Seyed-Forootan
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Corresponding author

Correspondence to Hamid Karimi.

Appendix

Appendix

A sample of our questionnaire about sexual satisfaction:

  1. 1.

    Do you have a partner?

  2. 2.

    Do you have sex with your partner?

  3. 3.

    How long after surgery, you started the sex?

  4. 4.

    How often you have sex during a week?

  5. 5.

    In how many percent of sexes, you are the one who start?

  6. 6.

    Do you have orgasm? In how many percent of sexes?

  7. 7.

    Do you have sensation inside your new vagina?

  8. 8.

    Are you satisfied with your sex? Yes, no, most of all yes, most of all no

  9. 9.

    Do you think that this satisfaction is related to your surgery?

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Seyed-Forootan, K., Karimi, H. & Seyed-Forootan, NS. Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-vagina in Male-to-Female Reassignment Surgery. Aesth Plast Surg 42, 491–497 (2018). https://doi.org/10.1007/s00266-018-1088-z

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  • DOI: https://doi.org/10.1007/s00266-018-1088-z

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