Vaginal reconstruction

Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent has enabled comfort for the patient and ease for the surgeon in maintaining skin graft approximation. For large vaginal and perineal defects, myocutaneous flaps, such as the gracilis island, have been extremely useful for correction of radiation tissue to the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensues since the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of three to six months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients.