Method of corset plasty of neophallus muscle

FIELD: medicine.

SUBSTANCE: muscle of the neophallus is mobilised. A corset is formed intra-operatively according to the diameter and length of a mobilised muscle from a mesh with non-absorbable polypropylene 0.5-0.6 mm thick monofilaments, with the porosity of 85-90%, with run-proof edges in case of resection. The muscle is circularly wrapped up with the formed corset.

EFFECT: provision of the sufficient rigidity of the neophallus and elimination of its deformation due to the application of the corset, formed from the mesh with non-absorbable polypropylene monofilaments.

2 ex

 

The invention relates to the field of medicine, namely urology, and andrology, and can be used in male genital surgery (in case of loss of the penis) and when masculinities correction for sex corset muscle plasty neophallus.

The primary task in neillandbrittany is the creation of a functional body that ensures the Commission of a sexual act, sexual rehabilitation and social adaptation of the patient.

Reconstructive plastic penis is one of the most difficult problems in male genital surgery.

Currently there are various ways to phalloplasty: phalloplasty Filatov way of skin and fat inguinal flap, etc. However, multistage methods, the lack of axial blood supply, impairing tissue trophism and complicating subsequent stages of urethroplasty and prosthetics, and lack of physical activity and adequate skin sensitivity neophallus is a significant shortcomings, which result in low efficiency of therapeutic interventions. [Kirpatovski I. D., Golubeva I. V. // Pathology and correction of sex / Publishing house of the Russian University of friendship of peoples. M - 1992. - P. 229].

The most effective solution to problems of plastic corresponds phalloplasty free thoracodorsal�th musculocutaneous flap, based on the latissimus dorsi muscle with preservation remove arteries, veins and remove motor nerve. Revascularization is due to the inferior epigastric vessels, and muscle reinnervation fundamentals flap motor branch of the obturator nerve.

[Adamyan, R. T. // Plastic and reconstructive microsurgery in the treatment of transsexualism /Diss. doctor. honey. science - M, 1996].

Reinnervation of muscle neophallus usually occurs within 4-12 months. When training patients achieve the muscle contraction of the flap and sufficient rigidity of neophallus, providing the sexual intercourse.

If the voltage neophallus does not meet patients, we performed the implantation of prostheses in neophallus. In some patients with reduced muscle neophallus is its deformation with shortening and nodular thickening, leading to the impossibility of implementation of introjection. To correct such deformation previously recommended bandaging phallus with condom use [W. Eicher // Trans-sexualismus Stuttgart-New York - 1984 - C. 190]. The majority of patients for aesthetic and functional reasons it was felt that this method was unacceptable.

After the restoration of motor activity muscle the basics of neophallus and the lack of sufficient rigidity in its reduction, and t�activate in the presence of deformation of neophallus patients perform corsetry fasciolasis muscle neophallus.

As a prototype we have chosen the way of corsetry fasciolasis muscle neophallus proposed N. About Milanowek, R. T. Adamyan et al. [Milanov N. About., Adamyan R. T., Kozlov G. I. // Correction of gender in transsexualism / M., 1999. - P. 151].

The intervention consists of a circular wrap mobilized muscle neophallus a fragment of the broad fascia of the thigh. In this way, a fascial sheath, which not only prevents the thickening and shortening, but also increases its rigidity.

When frame fasciolaria muscle neophallus in this way it is necessary to perform additional surgery on the hip with the release of a fragment of the broad fascia of the thigh, followed by grafting of the defect with fascia Lata and suturing wounds. The use of wide fascia of the thigh as a corset the muscles of neophallus does not provide sufficient rigidity, making it difficult to intreccio and implementation of sexual intercourse, affects sexual and social adjustment.

The object of the invention is to optimize sexual and social adaptation of patients after the formation of neophallus.

The technical result of the invention is to provide a sufficient rigidity of neophallus and elimination of its deformation when performing frame fasciolasis muscle neophallus with the exception of the additional operational BME�force on the hip that will reduce the trauma and reduce the time of transaction.

The technical result of the invention is achieved in that mobilize muscle neophallus and circular wrap her corset. Corset shape intraoperatively from polypropylene mesh respectively the diameter and the length of the mobilized muscle.

The method is as follows: After performing the steps of forming neophallus and restoration of motor activity in the absence of sufficient rigidity when it is reduced, and deformation of neophallus perform plastic corset his muscular framework.

The operation is performed with the patient supine. The midline of the ventral surface of neophallus an incision of the skin with subcutaneous tissue. Circular bluntly and sharply distinguish muscle neophallus, keeping the connection between the muscle and skin at the proximal and distal segments. Respectively the diameter and the length of the mobilized muscle cut out corset from polypropylene mesh, which circular mantle muscle and sutured over her non-absorbable sutures. The wound is sutured in layers.

We used an endoprosthesis for filter ESFIL, made of biologically inert non-absorbable polypropylene monofilament. Osnovana structure of the endoprosthesis - mesh provides prispuskaesh cu�EB when cut, and a special weave - dimensional stability and limited stretchability in all directions. An endoprosthesis for filter ESFIL have a small thickness (0.5-0.6 mm) and high porosity (85-90%), enabling fast and uncomplicated germination corset polypropylene mesh connective tissue [Catalog of the Company "Medicine and new technology" Esfil info(5)mednt.ru].

The associated analysis of the claimed solution with the prototype shows that the inventive method differs from the known fact that when corset muscle plasty neophallus no need surgical procedure to cut out a fragment of the broad fascia of the thigh. It is replaced by a polypropylene mesh, which reduces the time and reduces the trauma of surgery. The proposed method allows to eliminate the deformation of phallus and reach necessary for carrying out sexual intercourse rigidity that accelerates sexual and social rehabilitation of patients. These differences allow to draw a conclusion about conformity of the proposed method the criterion of "novelty."

The features distinguishing the claimed method from the prototype, not identified in other ways in the study of this and related areas of medicine and, therefore, provide the claimed method "significant difference". The inventive method and the positive results of its approbation correspond remodeling�active-plastic problems of male genital surgery for surgical correction of sex.

Give examples from clinical practice:

Example 1. Patient A. age 29. In April 2006, underwent one-stage phalloplasty remove the flap. Contraction of muscle the basics of neophallus occurred after 5 months. after your surgery. Six months after the recovery of contractility of the attempt to establish a sexual relationship is not possible, as muscle contraction of neophallus unreasonably (spherical) its thickening. In November 2007, the operation performed corset muscle plasty neophallus of the claimed method. The postoperative period was uneventful. After 4 weeks, reduction of muscle neophallus was not accompanied by a shortening and deformity of the organ, thus achieved considerable rigidity, simulating an erection. After 8 weeks, the patient successfully carried out the sexual act. Later abandoned the intention to produce populattion. Plans to start a family.

Example 2. Patient S., 32 years. Performed phalloplasty remove the flap in may 2008. Contraction of muscle the basics of neophallus occurred after 6.5 months. However the patient noted that when the voltage of the muscles neophallus significantly shortens and thickens. This deformation prevents the Commission of a sexual act. The patient is asked to produce falloprotezirovanie. In February 2009 op made�radio corset muscle plasty neophallus of the claimed method. The postoperative period was uneventful. When examining a patient after 6 weeks, the deformation of neophallus when muscle tension is absent.

The patient is satisfied with the result of surgery. At the follow-up visit six months later, the patient reported that has a female sexual partner. Indianapolisindiana not required.

Method developed at the Department of urology of the North-Western state medical University named after I. I. Mechnikov and was clinically tested in 5 patients with sex-change from female to male with a positive result. The postoperative period was uneventful. In the analysis of remote results until 3-5 years reported satisfactory outcomes, providing patients a full sexual rehabilitation and social adaptation in a new field.

Thus, the claimed method corset muscle plasty neophallus provides sufficient rigidity neophallus and eliminates deformation, at the same time eliminates additional surgery on the hip, unlike the prototype method, which reduces the trauma and shortens the surgery time, which helps improve sexual and social adaptation of the patient.

A way corset muscle plasty neophallus consisting of mobilization of the muscles of neophallus and circular�about wrapping her corset, characterized in that the corset shape intraoperatively respectively the diameter and the length of the mobilized muscle from the grid c non-absorbable polypropylene monofilaments thickness 0.5-0.6 mm, a porosity of 85-90%, with no melt edges during the resection.



 

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