Abdominoplastic secondary full-thickness skin graft vaginoplasty for male-to-female transsexuals.

When inversion of combined penile and scrotal skin flaps for vaginoplasty in male-to-female transsexuals has become impossible or has not led to functional results, alternative vaginoplasty techniques should be considered. Colocolpopoiesis involves major surgery and often leads to disappointing long-term results. An Abbé-McIndoe vaginoplasty applying split-thickness skin grafts often does not provide favorable results in the scarred area encountered after complications of skin flap inversion surgery. Because thicker skin grafts show less tendency to shrink, the use of a full-thickness skin graft has been advocated for vaginoplasty in females. In this paper, we present our technique of successful secondary vaginoplasty applying full-thickness skin grafts in six male-to-female transsexuals. In patients with sufficient groin and abdominal skin to spare, a miniabdominoplasty allows for acceptable donor site scarring combined with correction of the abdominal skin surplus. In flat-tummied patients, the conventional abdominoplasty will allow for sufficient skin to be harvested to ensure successful secondary vaginoplasty. Abdominoplastic vaginoplasty has been proven to provide a good alternative whenever a laparotomy is not favored or is contraindicated in secondary cases.