Eur J Plast Surg (2006) 29: 35–37
Neo-vaginal construction with subcutaneously based
gluteal-fold flaps: a case report
Received: 3 January 2005 / Accepted: 3 November 2005 / Published online: 31 March 2006
# Springer-Verlag 2006
Abstract A 16-year-old girl with vaginal aplasia had a 1-
cm long vaginal pouch and complete absence of uterus.
Bilateral subcutaneous based flaps were raised horizontally
from the gluteal folds and transposed into the created
vaginal cavity. At 12 months follow-up, she had success-
fully engaged in intercourse and at no time had been
mechanically using dilation. At clinical examination, the
neo-vagina maintained both adequate length and width.
Keywords Vaginal aplasia
Mayer–Rokitansky–Kuster–Hauser syndrome (MRKH)
describes vaginal agenesis with possible variable associated
organ abnormalities. Individuals with MRKH have normal
feminine appearance, and therefore, diagnosis is often de-
layed to the time of expected menorrhea. MRKH is gen-
erally thought to affect 1/5,000 liveborn female .
Techniques for construction of the vagina vary from
nonoperative procedures, through split-thickness grafts,
bowel vaginoplasty, and flap procedures . No ideal con-
structive procedure exists to date, as each of the above has
varying drawbacks in providing appropriate length, con-
sistency of width, simplicity in surgical technique and
degree of donor morbidity.
We report a new variation of vaginal construction using
bilaterally subcutaneous based gluteal-fold flaps. To our
knowledge, the use of the gluteal-fold flap in this context
has not been described previously.
A 16-year-old twin-girl with aplasia of the vagina was
referred for vaginal construction. The vaginal pouch was
1 cm, and there was complete absence of the uterus.
The construction was made by bilateral subcutaneous
based gluteal-fold flaps. A transverse incision was made at
the top of the vagina. Awide canal was made extraperitoneal
in the retrovesical space with the use of the blunt technique.
Two cutaneous flaps were raised from the gluteal folds
with their bases medially in the triangle between the
vaginal orifice, the anus, and the ischial tuberosity. The
flaps were based on a subcutaneous pedicle arising from
the internal pudendal artery (Fig. 1). The fascia was not
included in the flaps (Fig. 2). The flaps were tunneled into
the vagina and out through the introitus. They were sutured
together, creating a tube with the cutaneous layer as inner
lining (Fig. 3). The tube was transposed thereafter 180°
into the pelvic cavity. The donor defects were closed
directly (Fig. 4). Three drains were placed and maintained
for 1 week, during which the patient remained in bed.
Upon inspection 1 week after, the flaps were well vascu-
larized and healed. The vaginal length was more than 10 cm.
The patient was allowed to mobilize, although sitting for
long periods was prohibited for 3 weeks postoperative.
At 12 months postoperative, the patient had had un-
problematic sexual intercourse without the use of mechan-
ical dilation at any time. Vaginal width was 4 cm and
vaginal depth 10 cm as judged by finger measurement.
G. Toft (*)
Department of Plastic Surgery Z,
Aarhus University Hospital,
8000 Aarhus, Denmark