POST GRS REVISION PROCEDURES

SECONDARY VAGINOPLASTY

Occasionally early GRS operations failed to provide a functional vagina due to a lack of width and/or depth, and patients are unable to indulge in sexual activity without difficulty. Now, Secondary Vaginoplasty, designed to widen and extend the vaginal canal, is an available procedure, and two methods can be used depending on the size of the existing canal.

1. Full Thickness Skin Graft Vaginoplasty

This procedure is suitable for patients who currently have a 2-3 inch vaginal depth and require only an additional 1-2 inches. The operation involves harvesting a skin graft (common donor sites are the lower abdomen, stomach, and groin area), after which a linear scar will remain. (Patients with a tendency to develop keloid scars must be aware that this may occur.) The harvested skin is then grafted to the existing vaginal canal to provide additional depth.
Doctor Sanguan carries out a delayed skin graft technique using Vacuum Assisted Closure to ensure that the graft survives and takes to the existing canal lining completely.
If the patient does not have sufficient spare skin for a traditional graft, a Thick Split Thickness Skin Graft (which involves harvesting the skin to a greater depth) may be considered. However, Doctor Sanguan rarely carries out this procedure as the skin from the donor site is not thick enough, and graft contracture is very common.
The operation requires hospitalization for 7-9 days, after which it is important that the patient carries out regular dilation for 6 months to ensure no graft contracture.

2. Rectosigmoid Colon Vaginoplasty

This procedure can be used for patients with a current vaginal depth of 1-2 inches, in which case it is unlikely that there is insufficient spare skin for a full thickness skin graft. Doctor Sanguan, in co-operation with Doctor Toranis, performs an exploratory Laparotomy (an incision through the abdominal wall above the pubis, similar to a Caesarian section. 6-7 inches of the large intestine is then removed and grafted to the existing vaginal canal lining in order to provide additional depth. Occasionally, an additional skin graft at the vaginal opening is required.
The advantages of this technique are self-lubrication due to natural secretion in the new canal, and less likelihood of contracture.
However, complications including infection, leakage from anastomosis (the joining of blood vessels), intestinal obstruction and scar contracture, may occur if the doctor lacks experience.  
The operation also requires hospitalization for 7-9 days.

SECONDARY LABIAPLASTY

In early GRS treatments, surgeons were limited in their ability to provide good definition to the labia minora and to provide a natural looking external appearance. However, greater technical knowledge and skills mean it is now possible to significantly improve the cosmetic appearance,  through Secondary Labiaplasty        
V-Y Advancement Labiaplasty (named for the shape of the incisions) is a common technique whereby a full thickness skin graft is used to construct a new labia minora.
If the patient suffers from fat atrophy at the labia majora or mons pubis, lipofilling (fat injection) may be carried out

Depending on the degree of corrective surgery required patients may need 1 day’s hospitalization.

URETHROPLASTY

In a number of GRS treatments, surgeons have failed to remove excess spongy tissue from the Bulbospongiosus that surrounds the urethra, so that, during sexual arousal this tissue may enlarge and block the entrance to the vaginal canal.
Also, sometimes the opening to the urethra was set inappropriately high, making urination difficult. 
Urethroplasty involves the removal of the excess spongy tissue and the relocation of the urethra opening, and requires day surgery, or, occasionally 1 day’s hospitalization.

CLITOROPLASTY

Early GRS techniques did not include the reconstruction of a clitoris, and all the nerves and parts of the penis glans that could have been used were discarded.
It is, therefore, not possible to create a sensate clitoris, although, patients undertaking Urethroplasty can also be given a non-sensate clitoris molded from adjacent skin or urethral mucosa. 

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