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Abstract

Inspiration is progress, and progress is inspiration. Reconstructive procedures must be inspiring for both the patient and the surgeon. Once perceived, the spirit of reconstructive surgery will be present likewise initiating intrinsic motivation for an overall perfect result with respect to form and function.

Supplementary material

Video 3.1

The first video shows the microsurgical reestablishment of a new clitoral glans with the NMCS procedure including stimulation of the clitoral nerves, and the final result with a both-sided aOAP flap in a 40-year-old woman suffering from FGM type III (infibulation). The procedure starts with the detection of the aOAP-flap perforator on both sides using a Doppler probe. The aOAP-flap perforators are marked on both sides localized on the genitofemoral sulcus. After opening the vestibule in the midline dissection of both the clitoral stump and the clitoral nerves was carried out over the anteriorly placed OD-flap incision. The dorsal clitoral nerves are then stimulated for demonstrative purposes and prepared for the NMCS procedure. Therefore the nerves are transposed into the newly formed clitoral tip by using diagonal tunnels diagonally dissected into both-sided clitoral corpora. Forming of the reconstructed clitoral tip is then accomplished by using the tunica albuginea sutured together over the neurotized central part of the new clitoral tip. The final result is shown after vulvar opening, clitoral reconstruction with the NMCS procedure, prepuce reconstruction with a modified OD flap, and vestibular reconstruction with a both-sided aOAP flap (MP4 765303 kb)

Video 3.2

The second video shows the microsurgical reestablishment of a new clitoral glans with the NMCS procedure including excision of a significant clitoral cyst frequently found in the mutilated clitoral organ, and dissection of a both-sided aOAP flap in a 25-year-old woman suffering from FGM type III (infibulation). The procedure starts with the detection of the aOAP-flap perforator on both sides using a Doppler probe. The aOAP-flap perforators are marked on both sides of the genitofemoral sulcus as well as the OD flap. Then the vestibule is opened in the midline followed by dissection of the clitoral cyst over the anteriorly placed OD-flap incision. The clitoral cyst then is excised leaving the clitoral stump on the level of the middle clitoral corpora. The dorsal clitoral nerves are then dissected and prepared for later transposition into the center of the clitoral stump through diagonal tunnels dissected into the clitoral corpora. Forming of the new clitoral tip is then accomplished by using the tunica albuginea sutured together over the neurotized area. The final result is shown after vulvar opening, clitoral reconstruction with the NMCS procedure, prepuce reconstruction with a modified OD flap, and vestibular reconstruction with a both-sided aOAP flap (MP4 1647139 kb)

Video 3.3

The third video shows vulvar reconstruction with a both-sided aOAP flap following extended vulvectomy in a 39-year-old woman suffering from lichen sclerosus et atrophicus. Perforator dissection is detailed. Following partial vulvectomy the procedure starts with the detection of the aOAP-flap perforators on both sides using a Doppler probe. The aOAP-flap perforators are marked on both sides of the genitofemoral sulcus as well as extensions of the aOAP flaps. Then dissection of the aOAP flaps is shown including details in perforator dissection. The final result is shown after vulvectomy and both-sided aOAP-flap vulvar reconstruction (MP4 703559 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Dan mon O’Dey
    • 1
  1. 1.Department of Plastic, Reconstructive and Aesthetic Surgery Hand SurgeryCenter of Reconstructive Surgery of Female Gender Characteristics, Luisenhospital AachenAachenGermany

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