What does vaginal graft at Suporn grow onto?

[Apple]

Hello, I would like to ask about one detail of the Suporn technique. First, some background. In his case, the neovaginal cavity is lined with a skin graft, that is, a piece of skin that does not have any connection to the rest of the body. It has to be pressed onto existing tissue, from which oxygen will diffuse into the graft and soon capillaries will grow from the host tissue into the graft. At that point, the graft has "taken". I hope I'm describing it correctly.

This is in contrast to PI, where the neovaginal cavity is lined by skin that still has vascular and perhaps neural connection to the body. I think it's called a pedicled skin flap.

My question is: what does the graft in Suporn's case grow onto? Is it then basicaly fixed within the body? (In PI, I'd guess the vagina is a bit mobile.) The tissues surrounding the vaginal cavity are the rectum, colon, bladder, many muscles, and connective tissue all around... so I guess the graft attaches to lots of them...?

It seems to me that having a fixed vagina (Suporn) and a mobile vagina (PI) would be quite different in practice, yet I haven't seen this difference mentioned anywhere...

[AnonyMs]

I can't answer your question, but Dr Suporn has a paper on his technique you can download from his website. Perhaps that would be helpful.

[Jenna Marie]

I can't remember if I posted this before, but at least a couple of penile inversion surgeons say they anchor the vagina to some of the localized connective tissue and ligaments. My personal operation report describes it as merely "ligaments," unfortunately, without specifying which ones by name. It certainly does not seem "mobile" in any practical sense of the word (and there is often an actual skin graft used to close the end of the penile skin tube where the cervix would be in a cis woman, to boot).

http://www.genitalsurgerybelgrade.com/mtf_surgery_detail.php?Penile-inversion-technique/1

"Fixation of the vagina to the sacrospinous ligament is performed to achieve deep placement of the neovagina in the perineal cavity and to prevent prolapse."

http://www.europeanurology.com/article/S0302-2838%2812%2901560-6/visual/mmc1

"The assembled neovagina is inverted, inserted into the expanded rectoprostatic space, and secured to the sacrospinous ligament."


As a matter of fact, I've heard that Suporn's long bed rest recommendation is because prolapse is *more* likely in his method, which would suggest that the anchoring of pure skin grafts requires at least a few days to "take" versus stitching the vagina to internal ligaments during the initial operation.

[AnonyMs]

As a matter of fact, I've heard that Suporn's long bed rest recommendation is because prolapse is *more* likely in his method, which would suggest that the anchoring of pure skin grafts requires at least a few days to "take" versus stitching the vagina to internal ligaments during the initial operation.

I've been curious what the long bed rest and recovery is about, but I'm sure I've read somewhere that Dr Suporn says prolapse is impossible with his technique. I suppose it could be because of the long bed rest, but that would seem to be an odd way of looking at it.

His dilation regime seems to be pretty unusual as well.

[Jenna Marie]

AnonyMS : To be honest, I only have some anecdotal info on Suporn, so I could easily be wrong. Though I'm going to go out on a limb and say prolapse is *never* impossible - it happens to cis women, too. Only God could make a guarantee like that.

[Apple]

Btw, I have read that in cis women, the vagina is (obviously) anchored to the uterus and the uterus is anchored to several pelvic ligaments. During hysterectomy on cis women, the vagina would lose support and is surgically anchored to one of the ligaments.

[PinkCloud]

It grows or attaches itself to the tissues surrounding it. Maybe it is fastened to a ligament. The packing inside the neo vagina makes sure it that the tissues around will grow into and attaches to it. Takes at least 3-5 days. After that the packing can be removed.

Here is an MRI of a transwoman with her neo vagina.



As you can see, the skin used to line the vagina has grown and attached itself to the tissues that surrounds it. There is no "hole" or space created surgically, the skin is just folded between the bladder and rectum, and then the packing is pushed into it to create the space.

[Apple]

I forgot to add one thing which was at the back of my mind when I originally posted this topic on fixed vs. partly mobile vagina.

After surgeries in the abdominal or pelvic cavity, there is a tendency to form "adhesions", wherein a band of scar tissue binds 2 parts of tissue that are not normally joined together. It is a problem since the internal organs need to be mobile in order to allow full movement of the body, twisting and turning without overly stressing the organs, and for the organs themselves so that the organ's passages (intestine, fallopian tubes...) do not get obstructed.

That's what worries me about a vagina that is grown onto something (intestine, bladder) on all of its surface. One day, as the completely healed woman does a stressful yoga pose, she could for example damage her small intestine due to decreased mobility of the organs. So in this regard, vaginas made from pedicled skin flaps could be safer that vaginas made from skin grafts.