McIndoe Operation without Skin Graft: A New Neovaginal Prosthesis of Polylactic Acid (PLA)
Pedro Acién *
Department of Public Health, Sc.H. and Gynecology, School of Medicine, Miguel Hernandez University, Campus of San Juan, 03550 Alicante, Spain and Instituto de Ginecología P.A.A. 03002 Alicante, Spain.
Maribel Acién
Department of Public Health, Sc.H. and Gynecology, School of Medicine, Miguel Hernandez University, Campus of San Juan, 03550 Alicante, Spain and Instituto de Ginecología P.A.A. 03002 Alicante, Spain and Service of Obstetrics and Gynecology, San Juan University Hospital, Campus of San Juan, 03550 Alicante, Spain.
Miguel-Angel Oliva-Meyer
Department of Mechanical Engineering and Energy, Miguel Hernandez University, Campus of Elche, 03202 Alicante, Spain.
Miguel Sánchez-Lozano
Department of Mechanical Engineering and Energy, Miguel Hernandez University, Campus of Elche, 03202 Alicante, Spain.
Javier Martínez-Garcia
Department of Mechanical Engineering and Energy, Miguel Hernandez University, Campus of Elche, 03202 Alicante, Spain.
*Author to whom correspondence should be addressed.
Abstract
Historically, the creation of a neovagina with an inert prosthesis or synthetic mold and a split-thickness skin graft (McIndoe´s technique) has been the most common surgical procedure. The major inconvenient of this technique are those related with: 1) Making the skin graft and the permanent scar in the donor area; and 2) The prostheses used as mold; the material might be of certain weight and stiffness that can produce bedsore on the recto-vaginal septum or necrosis of the lowest portion of the urethra and hypospadias. To avoid the skin graft, currently, good results have been achieved by simply covering the prosthesis with Interceed®. And regarding the neovaginal prostheses, we have designed a new prototype of prosthesis anatomically adapted to the vagina of normal women and besides being lightweight, and designed with 3D technology it is made of polylactic acid (PLA, biodegradable polymer derived from lactic acid) that contributes to the epithelialisation of the vagina, and which has been patented and presented in 2nd International Meeting on Rokitansky syndrome (Warsaw, Poland, 26-28 May 2016). The main advantages of the modification of the McIndoe´s technique include: 1) The neovagina might be done without skin graft, ie, using only the PLA prosthesis and a biocompatible and biodegradable mesh (used as biogenerative scaffold), thus allowing an almost outpatient surgery, more easy, without further dermal scarring and providing women more comfort and functionality. And 2) Instead 8-9 days of admission to make cures at donor skin graft area, the patient can go home the next day. The McIndoe surgical procedure might then be the most appropriate, simplest and with best anatomical, sexual and psychological results of the surgical techniques for neovagina.
Keywords: Vaginal agenesis, MRKH syndrome, Rokitansky syndrome, neovaginal prosthesis, neovaginal mold, Polylactic acid (PLA), McIndoe technique.