Versatility of the free jejunum flap in vaginal reconstruction

Abstract

Vaginal reconstruction represents a very difficult challenge. Free jejunal flaps can be easily molded and adapted to solve complex cases restoring the width, length, and consistency of the "new" vagina without compromising the external genitalia and improving the lubrication while preserving sensation to clitoris.

Keywords: Free flap; intestinal interposition; jejunum flap; laparotomy scar; vagina reconstruction; vaginal fibrosis; vaginal stricture.

Figure 1

MRI T2WI in the sagittal plane after intravaginal gel administration depicts a lack of vaginal distention, and an abnormal homogenous diffuse high signal intensity in the vaginal walls, secondary to vaginal stenosis and fibrosis.

Figure 2

Flap molded as desired right after anastomosis to the deep inferior epigastric artery and vein and before insetting to reconstruct the new vagina.

Figure 3

Schematic drawing of the flap inset. Notice the particular design of the flap which allowed us to reconstruct the posterior wall of the vagina and at the same time\r\nelongate it.

Figure 4

CT in the sagittal plane after administration of iodinated contrast medium in the neovagina shows the size, shape, location, and intestinal pattern of the walls, as well as the excellent distention. The study confirms the absence of contrast leaks in the stump.