We describe the technique used in the case of a 23-year-old female patient who came to the clinic for primary amenorrhoea. Her phenotype was female, with normal external genitalia and internal genitalia with absence of vagina. Abdomino-pelvic ultrasonography reported aplastic uterus and bilateral renal microlithiasis; excretory urography was normal; abdominal CT was also normal and pelvic CT showed the existence of a hypoplastic uterus. X-ray of the left hand showed an approximate bone age of 17 years. Simple radiology of the dorsal-lumbar spine showed right lumbar scoliosis and asymmetry of the iliac crests. The colon study by barium enema was normal and no internal genitalia were detected in the rectal examination. Complementary studies: hormonal profile with FSH, LH, oestradiol, progesterone, testosterone, prolactin, were normal.
The patient was intensively studied and sent for medical evaluation to the Gynaecology, Endocrinology and Psychology Departments, until the final diagnosis of Mayer-Rokitansky-Kuster-Hauser Syndrome was completed and she was referred to Plastic Surgery for vaginal reconstruction.

The McIndoe technique was performed, with the following modification: taking and applying partial thickness skin grafts from the gluteal regions, which were manually cross-linked and fixed to a layer of haemostatic gel sponges in order to ensure intimate contact of the grafts with the newly formed vaginal walls. In total, 2 rectangular 8 x 6 cm sheets of Gelfoam® haemostatic gel sponge were taken, sutured together with 3-0 monocryl resorbable threads and placed on the silicone conformer to take its shape simulating a lining. The grafts were fixed to the conformer previously covered with Gelfoam® sponges, also using resorbable sutures. The new vaginal tunnel was created by blunt dissection according to the technique described by the original author, with a depth of 12 cm and a diameter of approximately 6 cm, without intraoperative eventualities and with placement of the aforementioned device, fixed to the vaginal neo-walls with non-absorbable 3-0 nylon suture. Finally, we applied external compressive treatment with compresses and a layer of transparent adhesive and girdle-type suspensory tape.

The initial dressing was discovered 10 days postoperatively, finding 100% integration of the grafts. We repositioned the conformer to hold it in place for 4 more weeks of continuous use and then 3 weeks of overnight conformer use was indicated. At 3 months postoperatively, she was instructed to begin sexual intercourse, which she had already agreed to schedule in order to obtain the best possible results from the technique, avoiding vaginal stenosis. One year after the operation, the patient has an active sexual life with satisfactory postoperative results.

