Jj. Hage et al., THE ANATOMIC BASIS OF THE ANTERIOR VAGINAL FLAP USED FOR NEOURETHRA CONSTRUCTION IN FEMALE-TO-MALE TRANSSEXUALS, Plastic and reconstructive surgery, 92(1), 1993, pp. 102-108
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.