NEOCOLPOPOIEZA CU PIELE LIBERA IN TRATAMENTUL AGENEZIEI VAGINALE

NEOCOLPOPOIEZA CU PIELE LIBERA IN TRATAMENTUL AGENEZIEI VAGINALE

V. Muntean*, Delia Mirela Muntean**

* Clinica Chirurgie IV, UMF “Iuliu Hatieganu”, Cluj-Napoca
**Spital Clinic CF, Cluj-Napoca
Spitalul Clinic Judetean de Urgenta Craiova

Rezumat

    In lucrarea de fata ne-am propus studiul retrospectiv al rezultatelor imediate si la distanta la 22 paciente cu agenezie vaginala operate într-un interval de 25 ani. La 10 paciente am facut neocolpopoieza cu piele libera despicata si la 12 cu piele libera toata grosimea.

   In perioada postoperatorie imediata s-au produs trei necroze partiale ale grefelor, toate tratate conservativ. In timp, tendinta de stenoza vaginala a fost observata la 5 din 7 paciente, toate cu plastie cu piele libera despicata. Din cele 15 paciente urmarite la distanta, sunt active sexual 13. Dintre acestea, 10 ajung la orgasm, 2 paciente descriu activitatea sexuala acceptabila si o pacienta prezinta dispareunie prin tendinta de stenozare a neovaginei. La pacientele cu agenezie vaginala, la care procedeul Frank si Geist nu este indicat sau esueaza, neocolpopoieza cu piele libera este metoda de electie, datorita simplitatii, riscurilor perioperatorii reduse si rezultatelor bune.

   Plastia cu piele libera toata grosimea realizeaza un aspect cosmetic superior si poate fi facuta oricand dupa pubertate, permitand dezvoltarea psihosexuala normala a pacientelor.

Abstract – NEOCOLPOPOIESIS WITH FULL THICKNESS GRAFT IN VAGINAL RECONSTRUCTION

    This is a retrospective study of immediate and long-term results of neocolpopoiesis in 22 female patients with vaginal agenesis operated during a 25 years interval. Split-thickness skin graft vaginal plasty was performed in 10 patients and full-thickness in 12. Immediate postoperative partial graft necrosis and loss was observed in three cases, all treated conservatively.

    During follow-up, 5 out of 7 patients with split-thickness skin graft had vaginal stenosis. In the late follow-up, 13 out of 15 patients were sexually active, 10 patients have orgasm during the sexual intercourse, 2 declare that they were reasonably satisfied with their sex life and one patient has dyspareunia because vaginal stenosis. When Frank and Geist procedure is not indicated or fails in patients with vaginal agenesis, the free skin neocolpopoiesis is the therapy of choice, because of the simplicity, low morbidity, and high success rate.

   Full-thickness skin graft vaginoplasty produces better anatomical results even without regular dilatation or frequent sexual intercourse and can performed anytime after puberty, providing a normal psychosexual development of the child.



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