Female Genital Mutilation Reconstruction: Surgical Technique

Abstract

Female genital mutilation (FGM) reconstruction has been shown to be a safe procedure that contributes to improvements in physical, emotional, and sexual health. Genital reconstructive procedures are increasing in demand, but access to these procedures is severely limited. This represents an opportunity for plastic surgeons to leverage their reconstructive expertise in delivering both functional and aesthetic rehabilitation to FGM survivors. The accompanying educational video demonstrates FGM reconstructive surgery, which consists of adjacent tissue rearrangement of the bilateral vulva with buccal mucosal grafting and structural fat grafting. Buccal mucosa grafts are designed and harvested to allow sufficient coverage of the defect to be restored. Local anesthetic infiltration and fat graft harvest are performed in the superior mons area. An inverted-Y incision is used to create de novo labia minora flaps and dissect the clitoral remnant. Vaginal sulci are re-created with imbrication of labia majora. The buccal grafts are shaped to resurface the defects and secured using bolsters fashioned out of Doyle splints covered with antibiotic ointment. Fat grafting is performed bilaterally into the labia majora and mons region, to provide protection and a conductive environment for sensory regeneration of the clitoral remnant. This technique produces an excellent improvement in contour, release of scar tissue, and labia minora reconstruction with a low complication rate. After surgery, patients have experienced a return in natural pigmentation and clitoral sensation. This straightforward, effective approach has been shown to improve physical, sexual, and psychological health in FGM survivors.