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CC BY 4.0 · Indian J Plast Surg
DOI: 10.1055/s-0045-1809412
Original Article

An Overview of Vaginoplasty Techniques: Spotlight on the Efficacy of the Horseshoe Labia Minora Flap

Authors

  • Rasheedha Begum

    1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India

  • Manimegala Philip

    1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India

  • Mahadevan Kandasamy 

    2   Department of Plastic and Reconstructive Surgery, Government Kilpauk Medical College, Kilpauk, Chennai, Tamil Nadu, India

  • Sridevi Shanmugam

    3   Institute of Research and Rehabilitation of Hand and Department of Plastic Surgery, Stanley Medical College, Chennai, Tamilnadu, India

  • Sugumar Muthachari

    1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
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Abstract

Background

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome involves vaginal agenesis and variable uterine development, often accompanied by renal, skeletal, and auditory anomalies. The primary objective of treatment is to reconstruct a neovagina that closely resembles the natural anatomy, enabling normal sexual function. This study evaluates various vaginoplasty techniques performed at our institution and their outcomes.

Materials and Methods

This retrospective study, conducted from January 2012 to January 2024, includes patients who underwent different types of vaginoplasty, including the McIndoe, Singapore flap, islanded pudendal flap, labia minora flap, and horseshoe modification of the labia minora flap. Procedures were chosen based on clinical examination. Outcomes were assessed using an institutional scoring system evaluating vaginal length, introitus diameter, neovaginal skin quality, and pain during intercourse.

Results

Twenty patients of primary vaginal agenesis (aged 18–27) diagnosed clinically and confirmed with pelvic MRI underwent vaginoplasty by the same surgical team. One (14.28%) patient of the McIndoe procedure experienced graft contracture, which was released and regrafted, while another (14.28%) had partial graft loss managed conservatively. No significant complications occurred in the remaining patients. All used a postoperative vaginal mould for three months. The average follow-up period was 18 months, with neovaginal length ranging from 6 to 10 cm.

Conclusion

The horseshoe modification of the labia minora flap offers a reliable, effective approach for vaginal reconstruction in cases of MRKH syndrome. This technique fulfils the basic tenets of plastic surgery, namely the restoration of form and function. The simplicity of the procedure and relatively short learning curve render it an attractive flap option even for the novice plastic surgeon.

Keywords

vaginoplasty - Mayer–Rokitansky–Küster–Hauser syndrome - McIndoe procedure - pudendal flap - Singapore flap - labia minora flap


Publication History

Article published online:
12 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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