Vulvar Reconstruction Following Female Genital Mutilation/Cutting (FGM/C) and other Acquired Deformities (eBook)

Dr. O`Dey received his PhD in medicine in 2011. His research focuses on composite anatomic vascular territories. Until 2013, he worked in the Department of Plastic Surgery, Hand Surgery, Burn Center at Aachen University Hospital. Since 2014 he is head of the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Center of Reconstructive Surgery of female gender characteristics at Aachen Luisenhospital, Teaching Hospital of the Aachen University of Technology (RWTH). Dr. O´Dey is an international speaker, the author of many scientific articles, fellow of EBOPRRAS, and member of DGPRÄC and ISAPS.   

Preface 5
Contents 7
1: Introduction 9
1.1 A General View 9
1.2 Female Genital Mutilation/Cutting (FGM/C) 9
1.3 Personal Trip to Tanzania 16
1.4 The European Community and FGM/C 18
1.5 The Ritual of FGM/C and Its Side Effects 18
1.5.1 Physical and Psychological Damage 18
1.5.2 Psychological Damage Without Physical Correlate 19
1.6 Other Acquired Deformities 20
1.6.1 Nonneoplastic Disorders 20
1.6.2 Neoplastic Disorders 23
1.6.3 Inflammatory Diseases 25
1.6.4 Functional Disorders 29
1.7 Justifying Indication for Reconstruction in FGM/C Patients 30
1.7.1 Importance of Reconstructive Surgery 32
1.7.2 Importance of Defibulation by Means of a Vulvar Opening Versus Vulvar Reconstruction in FGM/C Type III Patients 36
Literature 40
2: Basic Consideration 42
2.1 Clinical Setting 42
2.2 Patient Management 44
2.3 Clinical Management 45
2.4 Anatomy 46
2.4.1 Region of the Clitoris 46
2.4.2 Region of the Minor and Major Labias 50
2.4.3 Region of the Genitofemoral Sulcus 51
2.5 Pathology 53
Literature 54
3: Procedures 56
3.1 General Perspective 56
3.1.1 Surgical Instruments 56
3.1.2 Planning 57
3.1.3 Anesthesia and Preparation 57
3.1.4 Positioning 57
3.1.5 Perforator Dissection 58
3.2 Clitoral Reconstruction 59
3.2.1 General Perspective 60
3.2.2 Reconstruction of the Prepuce Using the Omega-Domed Flap (OD Flap) 60
3.2.2.1 Importance of the Clitoral Prepuce and the OD Flap 60
3.2.2.2 Operative Procedure of the OD Flap 63
3.2.3 Reconstruction of the Clitoral Glans: The Neurotizing and Molding of the Clitoral Stump (NMCS) Procedure (Video 3.1) 67
3.3 Complex Vulvar Reconstruction Following FGM Type III (Infibulation) 74
3.3.1 General Perspective 74
3.3.2 Vulvar Reconstruction with the Anterior Obturator Artery Perforator Flap (aOAP Flap) 76
3.3.2.1 General Perspective 76
3.3.2.2 The aOAP Flap Procedure (Video 3.2) 78
3.3.2.3 Advanced Vulvar Reconstruction with the aOAP Flap: The Split-aOAP Flap Technique 84
3.3.2.4 Full Vulvar Reconstruction After Vulvectomy (Video 3.3) 86
3.3.2.5 Reconstruction in FGM Type IV 86
3.3.2.6 Algorithm for Complex Vulvar Reconstruction 91
3.4 Adjunctives 93
3.5 Postoperative Care 93
3.5.1 Clitoral and Prepuce Reconstruction 94
3.5.2 Complex Vulvar Reconstruction 94
3.6 Management of Complications 94
3.6.1 General Perspective 95
3.6.2 Primary Complication 95
3.6.2.1 Pain 95
3.6.2.2 Swelling 96
3.6.2.3 Hematoma 96
3.6.2.4 Infection 96
3.6.2.5 Vascular Insufficiency and Tissue Loss 98
3.6.2.6 Psychological Distress 98
3.6.3 Secondary Complications 99
3.6.3.1 Scarring 99
3.6.3.2 Hair Growth of the Vestibule or Vaginal Introitus 100
3.6.3.3 Folliculitis of the Vestibule or Vaginal Introitus 100
3.7 Personal Perspective and Epilog 100
Literature 103