Veronica I. Alaniz , Kelly Harris , Kellie Woodfield , Julie Friedman , Vatche Melkonian , Andrea Bischoff
{"title":"将 AlloDerm 用于一名泄殖腔患者的阴道部分置换术的新方法:病例报告","authors":"Veronica I. Alaniz , Kelly Harris , Kellie Woodfield , Julie Friedman , Vatche Melkonian , Andrea Bischoff","doi":"10.1016/j.epsc.2024.102873","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>During cloacal reconstruction, vaginal replacement with an intestinal graft is considered when native vagina does not reach the perineum. Risks include need for revision surgery, mucus production, colitis, and rarely dysplasia. Given these concerns, alternative vaginal reconstructive procedures are being considered. We present a novel case using AlloDerm for vaginal replacement in a female infant undergoing cloacal reconstruction.</p></div><div><h3>Case presentation</h3><p>A 17-month-old female with a complex medical history including Stage 5 chronic kidney disease (CKD) underwent repair of a 4.5 cm cloaca via a posterior sagittal approach. Although the rectum was adequately mobilized off tension, the vagina remained 4 cm from the perineum when off tension. Because vaginal replacement using sigmoid colon would have required exploratory laparotomy in this medically complex child, decision was made to proceed with vaginoplasty using an AlloDerm graft. Two 2 × 4 cm pieces of AlloDermwere placed longitudinally to create the anterior and posterior vaginal walls. The lateral walls and surrounding fat were then secured and the introitus was created. Vaginoscopy was performed three months post-operatively and confirmed an intact graft approximately 2–3 cm long with a patent anastomosis to the native vagina.</p></div><div><h3>Conclusion</h3><p>AlloDerm is an acellular tissue matrix that supports tissue regeneration. This is a promising vaginal replacement option for patients with cloaca who are not good candidates for a colonic vaginoplasty. Future studies are needed to assess long-term outcomes of this graft for prepubertal vaginoplasties.</p></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.2000,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213576624001015/pdfft?md5=9730a4b79e617b1548d8c3665856d2cc&pid=1-s2.0-S2213576624001015-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Novel use of AlloDerm for partial vaginal replacement in a patient with cloaca: A case report\",\"authors\":\"Veronica I. Alaniz , Kelly Harris , Kellie Woodfield , Julie Friedman , Vatche Melkonian , Andrea Bischoff\",\"doi\":\"10.1016/j.epsc.2024.102873\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>During cloacal reconstruction, vaginal replacement with an intestinal graft is considered when native vagina does not reach the perineum. Risks include need for revision surgery, mucus production, colitis, and rarely dysplasia. Given these concerns, alternative vaginal reconstructive procedures are being considered. We present a novel case using AlloDerm for vaginal replacement in a female infant undergoing cloacal reconstruction.</p></div><div><h3>Case presentation</h3><p>A 17-month-old female with a complex medical history including Stage 5 chronic kidney disease (CKD) underwent repair of a 4.5 cm cloaca via a posterior sagittal approach. Although the rectum was adequately mobilized off tension, the vagina remained 4 cm from the perineum when off tension. Because vaginal replacement using sigmoid colon would have required exploratory laparotomy in this medically complex child, decision was made to proceed with vaginoplasty using an AlloDerm graft. Two 2 × 4 cm pieces of AlloDermwere placed longitudinally to create the anterior and posterior vaginal walls. The lateral walls and surrounding fat were then secured and the introitus was created. Vaginoscopy was performed three months post-operatively and confirmed an intact graft approximately 2–3 cm long with a patent anastomosis to the native vagina.</p></div><div><h3>Conclusion</h3><p>AlloDerm is an acellular tissue matrix that supports tissue regeneration. This is a promising vaginal replacement option for patients with cloaca who are not good candidates for a colonic vaginoplasty. Future studies are needed to assess long-term outcomes of this graft for prepubertal vaginoplasties.</p></div>\",\"PeriodicalId\":45641,\"journal\":{\"name\":\"Journal of Pediatric Surgery Case Reports\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.2000,\"publicationDate\":\"2024-09-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2213576624001015/pdfft?md5=9730a4b79e617b1548d8c3665856d2cc&pid=1-s2.0-S2213576624001015-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Surgery Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213576624001015\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Surgery Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213576624001015","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}
Novel use of AlloDerm for partial vaginal replacement in a patient with cloaca: A case report
Introduction
During cloacal reconstruction, vaginal replacement with an intestinal graft is considered when native vagina does not reach the perineum. Risks include need for revision surgery, mucus production, colitis, and rarely dysplasia. Given these concerns, alternative vaginal reconstructive procedures are being considered. We present a novel case using AlloDerm for vaginal replacement in a female infant undergoing cloacal reconstruction.
Case presentation
A 17-month-old female with a complex medical history including Stage 5 chronic kidney disease (CKD) underwent repair of a 4.5 cm cloaca via a posterior sagittal approach. Although the rectum was adequately mobilized off tension, the vagina remained 4 cm from the perineum when off tension. Because vaginal replacement using sigmoid colon would have required exploratory laparotomy in this medically complex child, decision was made to proceed with vaginoplasty using an AlloDerm graft. Two 2 × 4 cm pieces of AlloDermwere placed longitudinally to create the anterior and posterior vaginal walls. The lateral walls and surrounding fat were then secured and the introitus was created. Vaginoscopy was performed three months post-operatively and confirmed an intact graft approximately 2–3 cm long with a patent anastomosis to the native vagina.
Conclusion
AlloDerm is an acellular tissue matrix that supports tissue regeneration. This is a promising vaginal replacement option for patients with cloaca who are not good candidates for a colonic vaginoplasty. Future studies are needed to assess long-term outcomes of this graft for prepubertal vaginoplasties.