Skip to main content

The Use of Autologous Buccal Mucosa Grafts in Vaginal Reconstruction

Abstract

Vaginal reconstruction can be challenging when there is a paucity of tissue, as the ideal donor source has yet to be determined. Many of the existing and commonly used techniques, such as vaginal replacement with skin grafts or bowel segments, have both advantages and disadvantages. A novel technique for vaginal replacement and reconstruction is with autologous buccal mucosa, an epithelium which is an excellent tissue match to the vagina. As urologists often have extensive experience with the use of oral mucosa for urethral reconstruction, it is fitting to apply these techniques to procedures where native vaginal tissue is lacking. This review presents the existing literature as well as the author’s own experience with the use of autologous buccal mucosa for a variety of vaginal reconstructive procedures.

This is a preview of subscription content, access via your institution.

Fig. 1

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Thomas JC, Brock 3rd JW. Vaginal substitution: attempts to create the ideal replacement. J Urol. 2007;178:1855–9.

    Article  PubMed  Google Scholar 

  2. Hensle TW, Chang DT. Vaginal reconstruction. Urol Clin N Am. 1999;26:39–47. vii.

    Article  CAS  Google Scholar 

  3. O'Connor JL, DeMarco RT, Pope JCT, Adams MC, Brock 3rd JW. Bowel vaginoplasty in children: a retrospective review. J Pediatr Surg. 2004;39:1205–8.

    Article  PubMed  Google Scholar 

  4. Hensle TW, Shabsigh A, Shabsigh R, Reiley EA, Meyer-Bahlburg HF. Sexual function following bowel vaginoplasty. J Urol. 2006;175:2283–6.

    Article  PubMed  Google Scholar 

  5. Lima M, Ruggeri G, Randi B, Domini M, Gargano T, La Pergola E, et al. Vaginal replacement in the pediatric age group: a 34-year experience of intestinal vaginoplasty in children and young girls. J Pediatr Surg. 2010;45:2087–91.

    Article  PubMed  Google Scholar 

  6. Ursic-Vrscaj M, Lindtner J, Lamovec J, Novak J. Adenocarcinoma in a sigmoid neovagina 22 years after wertheim-meigs operation. Case report. Eur J Gynaecol Oncol. 1994;15:24–8.

    CAS  PubMed  Google Scholar 

  7. Schouten van der Velden AP, de Hingh IH, Schijf CP, Bonenkamp HJ, Wobbes T. Metachronous colorectal malignancies: “don't forget the neo vagina”. A case report. Gynecol Oncol. 2005;97:279–81.

    Article  PubMed  Google Scholar 

  8. Hiroi H, Yasugi T, Matsumoto K, Fujii T, Watanabe T, Yoshikawa H, et al. Mucinous adenocarcinoma arising in a neovagina using the sigmoid colon thirty years after operation: a case report. J Surg Oncol. 2001;77:61–4.

    Article  CAS  PubMed  Google Scholar 

  9. Malka D, Anquetil C, Ruszniewski P. Ulcerative colitis in a sigmoid neovagina. N Engl J Med. 2000;343:369.

    Article  CAS  PubMed  Google Scholar 

  10. Webster T, Appelbaum H, Weinstein TA, Rosen N, Mitchell I, Levine JJ. Simultaneous development of ulcerative colitis in the colon and sigmoid neovagina. J Pediatr Surg. 2013;48:669–72.

    Article  PubMed  Google Scholar 

  11. Banister JB, McIndoe AH. Congenital absence of the vagina, treated by means of an indwelling skin-graft. Proc R Soc Med. 1938;31:1055–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  12. Liebrich C, Reinecke-Luthge A, Kuhnle H, Petry KU. Squamous cell carcinoma in neovagina at mayer-rokitansky-kuster-hauser-syndrome. Zentralbl Gynakol. 2006;128:271–4.

    Article  CAS  PubMed  Google Scholar 

  13. Belloli G, Campobasso P, Musi L. Labial skin-flap vaginoplasty using tissue expanders. Pediatr Surg Int. 1997;12:168–71.

    Article  CAS  Google Scholar 

  14. Parsons JK, Tufaro A, Chang B, Schoenberg MP. Rectus abdominis vaginoplasty after anterior exenteration for urologic malignancy. Urology. 2003;61:1249–52. discussion 1253.

    Article  PubMed  Google Scholar 

  15. Selvaggi G, Monstrey S, Depypere H, Blondeel P, Van Landuyt K, Hamdi M, et al. Creation of a neovagina with use of a pudendal thigh fasciocutaneous flap and restoration of uterovaginal continuity. Fertil Steril. 2003;80:607–11.

    Article  PubMed  Google Scholar 

  16. O'Connell C, Mirhashemi R, Kassira N, Lambrou N, McDonald WS. Formation of functional neovagina with vertical rectus abdominis musculocutaneous (vram) flap after total pelvic exenteration. Ann Plast Surg. 2005;55:470–3.

    Article  PubMed  Google Scholar 

  17. Scott JR, Liu D, Mathes DW. Patient-reported outcomes and sexual function in vaginal reconstruction: a 17-year review, survey, and review of the literature. Ann Plast Surg. 2010;64:311–4.

    Article  CAS  PubMed  Google Scholar 

  18. Gargollo PC, Cannon Jr GM, Diamond DA, Thomas P, Burke V, Laufer MR. Should progressive perineal dilation be considered first line therapy for vaginal agenesis? J Urol. 2009;182:1882–9.

    Article  PubMed  Google Scholar 

  19. Baskin LS, Duckett JW. Buccal mucosa grafts in hypospadias surgery. Br J Urol. 1995;76 Suppl 3:23–30.

    Article  PubMed  Google Scholar 

  20. Lin WC, Chang CY, Shen YY, Tsai HD. Use of autologous buccal mucosa for vaginoplasty: a study of eight cases. Hum Reprod. 2003;18:604–7. The earliest and largest published series of autologous buccal mucosa for neovagina creation.

  21. Duckett JW, Coplen D, Ewalt D, Baskin LS. Buccal mucosal urethral replacement. J Urol. 1995;153:1660–3.

    Article  CAS  PubMed  Google Scholar 

  22. Kamp S, Knoll T, Osman M, Hacker A, Michel MS, Alken P. Donor-site morbidity in buccal mucosa urethroplasty: lower lip or inner cheek? BJU Int. 2005;96:619–23.

    Article  PubMed  Google Scholar 

  23. Simons JL, Vintiner SK. Efficacy of several candidate protein biomarkers in the differentiation of vaginal from buccal epithelial cells. J Forensic Sci. 2012;57:1585–90.

    Article  CAS  PubMed  Google Scholar 

  24. Stallings JO, Gills RE, Sessions DG. Free graft of vaginal mucosa to the mouth. Case report. Plast Reconstr Surg. 1971;47:498–501.

    Article  CAS  PubMed  Google Scholar 

  25. van der Bijl P, van Eyk AD. Human vaginal mucosa as a model of buccal mucosa for in vitro permeability studies: an overview. Curr Drug Deliv. 2004;1:129–35.

    Article  PubMed  Google Scholar 

  26. Yesim Ozgenel G, Ozcan M. Neovaginal construction with buccal mucosal grafts. Plast Reconstr Surg. 2003;111:2250–4. The earliest and largest published series of autologous buccal mucosa for neovagina creation

    Article  PubMed  Google Scholar 

  27. Zhao M, Li P, Li S, Li Q. Use of autologous micromucosa graft for vaginoplasty in vaginal agenesis. Ann Plast Surg. 2009;63:645–9.

    Article  CAS  PubMed  Google Scholar 

  28. Samuelson ML, Baker LA. Autologous buccal mucosa vulvovaginoplasty for high urogenital sinus. J Pediatr Urol. 2006;2:486–8.

    Article  PubMed  Google Scholar 

  29. Hyde SE, Hacker NF. Vaginal reconstruction in the fibrotic pelvis. Aust N Z J Obstet Gynaecol. 1999;39:448–53.

    Article  CAS  PubMed  Google Scholar 

  30. Lees DH, Singer A. Vaginal surgery for congenital abnormalities and acquired constrictions. Clin Obstet Gynecol. 1982;25:883–95.

    Article  CAS  PubMed  Google Scholar 

  31. Fowler JA, Goodman GP, Evans JM, Schober JM. Long-term vaginal sequelae secondary to pediatric pelvic fracture. J Pediatr Adolesc Gynecol. 2009;22:e15–9.

    Article  PubMed  Google Scholar 

  32. Creighton SM, Minto CL, Steele SJ. Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood. Lancet. 2001;358:124–5.

    Article  CAS  PubMed  Google Scholar 

  33. Krege S, Walz KH, Hauffa BP, Korner I, Rubben H. Long-term follow-up of female patients with congenital adrenal hyperplasia from 21-hydroxylase deficiency, with special emphasis on the results of vaginoplasty. BJU Int. 2000;86:253–8. discussion 258-259.

    Article  CAS  PubMed  Google Scholar 

  34. Stikkelbroeck NM, Beerendonk CC, Willemsen WN, Schreuders-Bais CA, Feitz WF, Rieu PN, et al. The long term outcome of feminizing genital surgery for congenital adrenal hyperplasia: anatomical, functional and cosmetic outcomes, psychosexual development, and satisfaction in adult female patients. J Pediatr Adolesc Gynecol. 2003;16:289–96.

    Article  PubMed  Google Scholar 

  35. Oakes MB, Beck S, Smith YR, Quint EH, Park JM. Augmentation vaginoplasty of colonic neovagina stricture using oral mucosa graft. J Pediatr Adolesc Gynecol. 2010;23:e39–42. Covers the existing literature regarding the use of autologous buccal mucosa in vaginal reconstruction.

    Article  PubMed  Google Scholar 

  36. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol. 2008;198(34):e31–7.

    Google Scholar 

  37. Morley GW, DeLancey JO. Full-thickness skin graft vaginoplasty for treatment of the stenotic or foreshortened vagina. Obstet Gynecol. 1991;77:485–9.

    CAS  PubMed  Google Scholar 

  38. Rourke K, McKinny S, St Martin B. Effect of wound closure on buccal mucosal graft harvest site morbidity: results of a randomized prospective trial. Urology. 2012;79:443–7.

    Article  PubMed  Google Scholar 

  39. Kubota A, Kawahara H, Okuyama H, Oue T, Tazuke Y, Ihara Y, et al. Endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula. J Pediatr Surg. 2003;38:1775–7.

    Article  CAS  PubMed  Google Scholar 

  40. Tang S, Dong N, Tong Q, Wang Y, Mao Y. Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula. Pediatr Surg Int. 2007;23:1077–80.

    Article  PubMed  Google Scholar 

  41. Piper HG, Trussler A, Schindel D. Gracilis transposition flap for repair of an acquired rectovaginal fistula in a pediatric patient. J Pediatr Surg. 2011;46:e37–41.

    Article  PubMed  Google Scholar 

  42. Grimsby GM, Fischer AC, Baker LA. Autologous buccal mucosa graft for repair of recurrent rectovaginal fistula. Pediatr Surg Int. 2014. Covers the existing literature regarding the use of autologous buccal mucosa in vaginal reconstruction.

  43. Jang TL, Erickson B, Medendorp A, Gonzalez CM. Comparison of donor site intraoral morbidity after mucosal graft harvesting for urethral reconstruction. Urology. 2005;66:716–20.

    Article  PubMed  Google Scholar 

  44. Markiewicz MR, DeSantis JL, Margarone 3rd JE, Pogrel MA, Chuang SK. Morbidity associated with oral mucosa harvest for urological reconstruction: an overview. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2008;66:739–44.

    Article  Google Scholar 

  45. DeJusta D, Granberg C, Bush N, Prieto J, Baker LA. Vaginoplasty with autologous buccal mucosa graft: a close histological match. Washington DC: American Urological Association Annual Meeting; 2011.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Gwen M. Grimsby and Dr. Linda A. Baker each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Linda A. Baker.

Additional information

This article is part of the Topical Collection on Pediatric Urology

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grimsby, G.M., Baker, L.A. The Use of Autologous Buccal Mucosa Grafts in Vaginal Reconstruction. Curr Urol Rep 15, 428 (2014). https://doi.org/10.1007/s11934-014-0428-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-014-0428-z

Keywords