THE ANATOMIC BASIS OF THE ANTERIOR VAGINAL FLAP USED FOR NEOURETHRA CONSTRUCTION IN FEMALE-TO-MALE TRANSSEXUALS

For lengthening of the urethra in female-to-male transsexuals, an ante rior vaginal wall flap is used. This flap is separated from the poster ior urethral wall down to the attachment at the urethral meatus follow ing a glistening cleavage plane. In this paper we present the anatomic and histologic basis of this flap. Prior to this, the relevant vagina l anatomy will be discussed. The anterior vaginal wall and posterior u rethral wall are not indissectable structures; this is true even in th e caudal two-thirds of the urethra. A long and narrow flap can be rais ed, thanks to the abundant vascular supply of the vaginal wall and the musculomucosal quality of the flap. A previously performed anatomic a nd histologic survey of the anterior vaginal wall has shown that the g listening cleavage plane is not composed solely of fascia, but rather consists of longitudinal strands of muscle, fibrous tissue, and elasti n.