ARTICLE | INVASIVE SURGERY |
and placed at the superior half of the cranioÐ caudal length of labia minora. Then, for each side of the labia minora, a similar suture is tightened, but in two halves, catching half the length of the labia minora in each clamp. Another technique is wedge resection (with or without
Z-plasty depending on the patientÕs presentation), which may be carried out in the central portion of the labia minora, or the inferior portion of the labia minora, leaving an intact outer border of labia. However, the patient will be at risk of neuroma or numbness when performing this technique. The de-epithelisation technique, first described by , is a safe method to reduce the width of the
Choi and Kim5 The amputation technique is based on placing a
clamp for the full longitudinal (cranioÐ caudal) extension of the labia minora, one for each side. The clamp must extend for the whole length of the labia minora, after which a knot is placed superiorly at the head of the clamp (i.e. at the upper part of the labia minora itself), and the thread is then passed in a continuous way (as in a continuous in-and-out suture) over the clamp and into the labia minora ® repeatedly ® until reaching the lower part of the labia minora near the fourchette. Then, carefully, the clamp is taken out from under the thread, and the thread is drawn and tightened in a knot. There are only two knots: one at the north of the labia minora and the other at the south. A variation of the technique is to place two face-to-face
clamps; that is, one clamp with its head up that should be placed at the lower half of the cranioÐ caudal extension of the labia minora, and the other clamp with its head down
Figure 6 (A) Pre-operative and (B) pos-toperative appearance from a standing position
labia minora, leaving the free outer edge intact. A variation of this last technique is the complete exeresis of the central part of the labia minora, creating a complete window through the thickness (i.e the bullÕs eye technique). In both cases, the suture which follows achieves a reduction to the width of the labia. A range of other techniques are also available using laser instruments, though the author is not keen on their use in this area. The authors follow a step-by-step technique when
undertaking labia minora plasty, which is mainly a de-epithelisation technique that may (or preferably not) be followed by a resection of the free outer border of labia minora. The aim is to fit the technique to the individual patient, in order to plan the best way in which to obtain a stable and good result, and without any complications. The patient whose pre-, post- and intra-operative pictures are given (and who gave consent for them to be shown here) is a young female in her 20s who explained that she feels embarrassed in a swimming suit and uncomfortable when riding a bicycle. She had
The authors follow a step-by-step
technique when undertaking labia minora plasty, which is mainly a
de-epithelisation technique that may (or preferably not) be followed by a
resection of the free outer border of labia minora.
asked another surgeon for this kind of surgery, but disliked his proposed amputation technique, preferring the authorsÕ technique. The technique that the author uses is very simple and
can be performed both under general anaesthesia ® as with the patient depicted in the Figures ® or under local anaesthesia plus intravenous sedation. The technique may, of course, be performed on one side only, as in the case of labia minora asymmetry.
34 ❚
Figure 7 Post-operative evaluation (as compared with Figures 1–4)
September 2012 |
prime-journal.com
Results By using this technique, the authors aim to make understood that the use of the bullÕs eye technique is not necessary, and the aim to maintain the free border intact may be achieved with a more careful de-epithelisation of their inner and
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