The Málaga flap for vaginoplasty in the Mayer-Rokitansky-Kuster-Hauser syndrome: experience and early-term results.

We report our experience in vaginoplasty for the treatment of six cases of the Mayer-Rokitansky syndrome using bilateral vulvoperineal fasciocutaneous flaps measuring 8 to 9 X 3 cm. We consider a detailed description of the operative technique, noting the modifications that we have introduced as our experience increased, in addition to the cosmetic and functional results. On the other hand, the indications for using this vaginoplasty are presented. On the basis of our clinical results, the actual anatomy of the blood vessels leading to the pedicle of the flap, and the geometric design of the vulvoperineal flap, the following technical points can be made: (1) It is a secure and reliable technique because of well-established vascularization beneath the lateral border of the labia majora. (2) It is a straightforward method because the transposition and rotation of a vertical flap is easier than the use of more distant flaps. (3) There is a minor risk of injury to the superficial perineal neurovascular pedicle and Bartholin's gland. (4) Innervation extends into the external two-thirds of the artificial vagina. And (5) an acceptable cosmetic and functional result is achieved without the need to use dilators, obturators, or molds.