We describe the technique used in the case of a 23-year-old patient who comes to consultation for primary amenorrhea.
The phenotype was female, with normal external genitalia and internal genitalia without vagina.
Abdominal ultrasound revealed aplastic uterus and bilateral renal microlithiasis. Excretory urography was normal. Abdominal CT was also normal and pelvic showed the existence of a hypoplastic uterus.
X-ray of the left hand showed a bone age of approximately 17 years.
The plain radiograph of the dorsolumbar spine showed right lumbar scoliosis and iliac crests.
The study of colon by opaque enema was normal and in the rectal examination no internal genitals were detected.
Seizures: hormonal profile with FSH, LH, estradiol, progesterone, testosterone, prolactin were normal.
The patient was studied ardually and sent to the Departments of Vaginal Pathology and Endocrinology and Psychology to complete the final diagnosis of Mayer-Rokitansky-Kustesian Reconstructive Surgery.
1.
McIndoe's technique was performed, with the following modification described: taking and applying partial thickness skin grafts of the glue regions, which have been reticulated manually and arranged in an intimate contact gel with layers.
In total, 2 rectangular 8 x 6 cm plates of gelfoam gelfoam® were taken, which were sutured with resorbable threads of the type monocryl 3-0 silicone to be adopted.
The grafts were fixed to the shaper previously covered with Gelfoam® sponges, also by resorbable sutures.
We performed the creation of the new vaginal tunnel by blunt dissection according to the technique described by the original author, with a dimension of 12 cm deep and approximately 6 cm in diameter, without any eventualities in the intraoperative period and with placement of the nyl device.
Finally, we placed an external compressive dressing with compresses and a transparent adhesive layer and a pan-type suspensory dressing.
1.
The initial cure was discovered 10 days after surgery integration of grafts at 100 %.
A new shaper was placed for the maintenance of this condition for 4 more weeks of continuous use and then 3 weeks of shaper use were indicated during the night.
At 3 months after surgery, the patient was instructed to initiate sexual intercourse that he had already agreed to schedule in order to obtain the best possible results of the technique, avoiding vaginal stenosis.
One year after surgery, the patient has an active sexual life with a satisfactory postoperative period.
