{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:13:03Z","timestamp":1779167583191,"version":"3.51.4"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>One of the biggest challenges with gender\u2010affirming vaginoplasty was the creation of a long\u2010lasting, durable, patent, and self\u2010lubricating neovaginal canal that allowed for spontaneous, pain\u2010free sexual intercourse. The jejunum was a durable, physiologic, and intestinal option to create the neovaginal canal that minimizes the adverse effects of skin graft, peritoneal, and colonic vaginoplasties. Free jejunal vaginoplasties had been performed in cis females for congenital genitourinary anomalies like Mullerian agenesis or after gynecologic\u2010oncologic surgery but had yet to be reported for gender\u2010affirming vaginoplasties. The purpose of this report was to present a technique for a physiologic, intestinal, gender\u2010affirming vaginoplasty without the disadvantages of colonic vaginoplasties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>This report presented six patients, all natal males who identified as female, undergoing robotic\u2010assisted free jejunal flap gender\u2010affirming vaginoplasty. Mean age was 35.8\u2009years (range: 21\u201366). Mean body mass index was 33.2\u2009kg\/m<jats:sup>2<\/jats:sup> (range: 28.0\u201341.0). The proximal aspect of the neovaginal canal was created intra\u2010abdominally by elevating peritoneal flaps from the posterior bladder wall to be reflected downward into the external neovaginal canal. The jejunal flap was harvested. The greater saphenous vein was harvested to create an arteriovenous loop between the flap vessels and the recipient femoral artery in an end\u2010to\u2010side fashion and a branch of the femoral vein. The jejunal flap was passed intra\u2010abdominally through the groin incision and then trans\u2010peritoneally into the neovaginal canal. The jejunal segment was inset to the proximal peritoneal flaps and the distal inverted penoscrotal skin of the neovaginal introitus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean length of the harvest jejunal segment was 19.2\u2009cm (range: 15\u201320). Mean time to ambulation, foley removal, and first vaginal dilation were 3.3 (range: 3\u20134), 4.0 (range: 3\u20135), and 4.5\u2009days (range: 4\u20136), respectively. By a mean follow\u2010up duration of 8.0\u2009months (range: 1\u201314), mean vaginal depth and diameter were 7.0 and 1.3\u2009cm (range: 1.0\u20131.5), respectively. Two (33.3%) patients experienced postoperative complications, including groin hematoma (<jats:italic>n<\/jats:italic>\u2009=\u20091, 16.7%) and reoperation for correction of dehiscence of the jejunal flap to the vaginal introitus (<jats:italic>n<\/jats:italic>\u2009=\u20091, 16.7%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Gender\u2010affirming surgeons should consider a free vascularized segment of jejunum as an option to line the neovaginal canal in the correct patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31202","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T05:06:44Z","timestamp":1718687204000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The robotic\u2010assisted free jejunal flap for neovaginal canal creation in gender\u2010affirming vaginoplasties"],"prefix":"10.1002","volume":"44","author":[{"given":"Gabriel A.","family":"Del Corral","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian L.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian X.","family":"Lava","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Georgetown University Hospital  Washington DC USA"},{"name":"Georgetown University School of Medicine  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen R.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Georgetown University Hospital  Washington DC USA"},{"name":"Georgetown University School of Medicine  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Lisle","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.SAP.0000058504.64374.80"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2009.04.066"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2011.02494.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199603000-00016"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12274"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199604000-00010"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/2000656X.2011.613649"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2017.44.1.48"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004122"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001459"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20713"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20562"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.SAP.0000466781.69925.b2"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.2000.3342"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2019.07.006"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.31202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T10:20:41Z","timestamp":1721211641000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.31202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,17]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1002\/micr.31202"],"URL":"https:\/\/doi.org\/10.1002\/micr.31202","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,17]]},"assertion":[{"value":"2023-01-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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