<< Back to the abstract archive
The use of a Hartmann's pouch for bowel vaginoplasty: A Case Report
Peter W Zak MD, Ian Chow MD, Xiao Zhu MD, Harry W Sell Jr. MD, Paul J Rusilko DO, Guy M Stofman MD
University of Pittsburgh Medical Center Department of Plastic Surgery
2021-01-31
Presenter: Ian Chow, MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Vu T. Nguyen, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
The literature on vaginal reconstruction using a pedicelled segment of bowel is largely limited to cases of vaginal agenesis requiring creation of a neo-vagina, male-to-female transgender reassignment surgery where inverted phallus skin is not sufficient, or as a revision procedure after failure of the primary reconstruction or complications such as vaginal stenosis in transgender surgery. Bowel vaginoplasty is a well-described procedure utilizing a pedicled segment of either the small or large intestine. Acquired vulvar and vaginal defects present a more complicated challenge to the reconstructive surgeon as many of these patients have large wounds and prior radiation requiring complex reconstructions. We present a novel case report of a patient with a history of previous irradiation, a large vulvar defect, vaginal stenosis, and a Hartmann's mucocele who was successfully managed with a unilateral gracilis flap, thigh advancement flaps, and bowel vaginoplasty using a Hartmann's pouch. Such an approach not only allowed for drainage of a large symptomatic Hartmann's mucocele and a symptomatic urethral stricture but also provided the patient with a functional introitus and vaginal canal. This report provides the first described use of a Hartmann's pouch for the creation of a neo-vagina. We believe the usage of a such a technique provides a viable salvage operation in the setting of an irradiated and inhospitable perineal defect.
