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

This book describes essential operative techniques that can be used to anatomically reconstruct the outer female genital in acquired deformities derived from ritual genital mutilation/cutting, and diseases causing similar deforming defects. Following an introduction with general insights on the topic, the main chapters deal with basic considerations and special anatomical information. With the help of high-quality videos and images, the reader receives detailed instructions on clitoral and vulvar reconstruction with techniques invented by the author, named the NMCS-procedure, the OD-flap and the aOAP-flap procedures. The book is rounded out with chapters describing postoperative care and how to manage complications.The integrity of their outer genitals is important for patients' physical and psychological wellbeing. As such, the vulva is now receiving increasing attention and will likely continue to grow in importance in plastic surgery. The author, who has developed outstanding procedures for vulvar and clitoral reconstruction over the years, shares his considerable experience and hopes to highlight the importance of these methods to overcome the burden of female genital mutilation/cutting.

Autorentext

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.

Inhalt

Chapter 1. Introduction

1. A general view

2. Female Genital Mutilation/Cutting (FGM/C)

3. Personal trip to Tanzania
4. The European Community and FGM/C
5. The Ritual of FGM/C and its Side effects

5.1 Physical and psychological damage

5.2 Psychological damage without physical correlate

6. Other acquired Deformities

6.1 Non-neoplastic disorders

6.2 Neoplastic disorders

6.3 Inflammatory diseases

6.4 Functional disorders

7 Justifying indication for Reconstruction in FGM/C patients

7.1 Importance of Reconstructive Surgery

7.2 Importance of Defibulation by means of a vulvar opening versus vulvar reconstruction in FGM/C Type III patients

Chapter 2: Basic Consideration

1. Clinical Setting

2. Patient Management

3. Clinical Management
4. Anatomy 4.1 Region of the clitoris

4.2 Region of the minor and major labias

4.3 Region of the genito-femoral sulcus

5. Pathology Chapter 3: Procedures

6. General perspective

1.1 Surgical instruments

1.2 Planning

1.3 Anesthesia and Preparation

1.4 Positioning

1.5 Perforator dissection

2. Clitoral reconstruction 2.1 General perspective 2.2 Reconstruction of the prepuce using the Omega-Domed flap (OD-flap)

2.2.1 Importance of the clitoral prepuce and the OD-flap

2.2.2 Operative procedure of the OD-flap

2.3 Reconstruction of the clitoral glans: The Neurotizing and Molding of the Clitoral Stump- (NMCS-) Procedure (Video 1)

3. Complex vulvar reconstruction following FGM Type III (Infibulation) 3.2 Vulvar reconstruction with the anterior Obturator Artery Perforator flap (aOAP-flap) 3.2.1 General perspective 3.2.2 The aOAP-flap procedure (Video 2)

3.2.3 Advanced vulvar reconstruction with the aOAP-flap: The split-aOAP-flap technique

3.2.4 Full vulvar reconstruction after vulvectomy (Video 3)

3.2.5 Reconstruction in FGM Type IV

3.2.6 Algorithm for complex vulvar reconstruction

4. Adjunctives

5. Postoperative Care

5.1 Clitoral and Prepuce reconstruction*

5.2 Complex Vulvar Reconstruction

6. Management of Complications

6.1 General perspective 6.2 Primary Complication 6.2.1 Pain

6.2.2 Swelling

6.2.3 Hematoma

6.2.4 Infection

6.2.5 Vascular insufficiency and tissue loss

6.2.6 Psychological distress

6.3 Secondary Complications

6.3.1 Scarring 6.3.2 Hair growth of the vestibule or vaginal introitus 6.3.3 Folliculitis of the vestibule or vaginal introitus

7. Personal perspective