PURPOSE: Female Genital Mutilation (FGM) reconstruction is a safe procedure that contributes to improvements in physical and emotional sexual health. The accompanying educational video demonstrates our refined approach to FGM reconstructive surgery, which consists of adjacent tissue rearrangement of the bilateral vulva with buccal mucosal grafting and structural fat grafting.
METHODS: First, buccal mucosa grafts are designed and harvested to allow coverage of the defect to be restored. Fat is harvested from the inferior abdomen via standard Coleman technique. An inverted Y incision of the vulva is used to release scar tissue and the clitoral remnant, create de Novo labia minora flaps, and recreate the interlabial sulci. Bilateral interlabial sulci are recreated with lateral imbrication of labia majora. The buccal flaps are shaped to resurface the raw regions of the clitoral remnant and lateral de Novo labia minora flaps. The reconstructed region is protected using bolsters fashioned out of silicone Doyle splints fixed into position in the bilateral interlabial sulci. Fat grafting is performed bilaterally into the upper labia majora and mons region.
RESULTS: This technique produces an excellent improvement in contour, release of scar tissue, and labia minora reconstruction with a low complication rate. Post-operatively, patients have experienced a return in natural pigmentation, clitoral sensation, and sexual function.
CONCLUSION: This straightfoward, effective approach has been shown to improve physical, sexual, and psychological health in FGM survivors.
