Vaginoplasty with a pudendal-thigh flap in intersexuals

To date, many procedures have been reported for vaginoplasties in intersexual patients, such as the McIndoe procedure, the perineal flap and the buttock flap. However, all of these procedures have disadvantages. We have performed vaginoplasties in many male-to-female transsexual patients with the modified pudendal-thigh flap and have found it to be a valuable flap free from complications. The advantages of the pudendal-thigh flap are that it can be elevated safely while retaining good vascularity, it provides for the construction of a sufficiently deep vagina without a skin graft and the donor scar is not so remarkable. Herein we report 2 different types of intersexual patients who underwent vaginoplasty with the pudendal-thigh flap. One was a female with Androgen Insensitivity Syndrome for whom we reconstructed the total vagina with a pudendal-thigh flap, and the other was a female with an Adrenogenital Syndrome for whom we enlarged the introitus of the vagina with the same approach. There were no complications such as flap necrosis. In addition there was no stricture of the neo-vagina and no urinary problems.