J Cosmet Med.  2018 Jun;2(1):57-62. 10.25056/JCM.2018.2.1.57.

How to ensure clitoral bud survival in a sexual reassignment surgery for transsexualism

• Pumsup J

• KMID: 2561054
• DOI: http://doi.org/10.25056/JCM.2018.2.1.57

Abstract

Background
Sexual reassignment surgery (SRS) is the complicated procedure as it has a very high risk of complications. The loss of clitoris is the ones. Accordingly, surgeons should carefully consider the surgical technique and ensure no mistakes during operation. Although most surgeons perform the operation carefully, a considerable incidence of clitoral bud necrosis has been reported. Thus, finding techniques that improve the success rates in surgeries is very important.
Objective
We aimed to study the cause of neo-clitoral bud necrosis after SRS in order to devise a mechanism to avoid neo-clitoral bud necrosis, and to find a surgical technique for ensuring the survival of the clitoral bud.
Methods
The study was conducted in 20 patients, who underwent a male-to-female SRS via Author technique From Juthapot Clinics, Trad Hospital, and Private Hospital (couldn’t mention) during September 2016 to August 2017. This intervention included various factors as mention below.
Results
Of the 20 patients who underwent the procedure with this technique, 18 patients were without clitoral bud necrosis and 2 patients had partial clitoral bud necrosis at the tip. Sensation was preserved in these patients, although it was decreased. The sensation has 2 part: the 1st part is neoclitoris and the 2nd is at the anterior vagina, that made by the urethral lining after spatulation, that can serve the sensation.
Conclusion
This technique may be useful for increasing the survival rate of clitoral buds. Further, this technique comprised multiple factors to ensure the success of the procedure. We found that sharp-scissor dissection promoted better outcomes than electrocautery dissection because of the thermal effect. Moreover, bipolar electrocautery procedures should be used to stop bleeding. Dissection should be deep to remove some layers of tunica albuginea. Furthermore, the width of the neurovascular strip must cover the dorsal nerve laterally. The clitoral bud size was not related to necrosis, but was associated with sensation. Finally, one must be careful about neurovascular strip compression, kinking, and twisting to ensure surgical success.

Keyword

clitoris; clitoral bud; clitoral bud survive; neo-clitoris; sexual reassignment surgery; transgender surgery