Female Genital Mutilation Reconstruction: Surgical Technique
Sarah Barnett, BAa, Elizabeth Card, MDb, Ivona Percec, MD, PhDa,b | aPerelman School of Medicine; bDivision of Plastic Surgery, Department of Surgery; University of Pennsylvania, Philadelphia, PA
Aim
•to describe a technique of clitoral and labial reconstruction for female genital mutilation (FGM) Types II and III refined over years of experience by the senior author
Background
•an estimated 200 million women and girls are affected by FGM worldwide1
•incidence is increasing in the US with increasing immigrant populations2
•there is limited access and literature about FGM reconstruction3
Methods
•from September 2016 to present, the following technique has been practiced for FGM repair at our institution
Steps:
1.harvest buccal mucosa graft
2.harvest and process suprapubic and abdominal fat
3.design an inverted-Y incision encompassing the scar
4.excise scar and release clitoral remnant
5.raise medially-based de novo labia minora flaps
6.imbricate medial labia majora to create labial sulcus
7.place buccal graft to lateral side of de novo labia minora flaps and bolster with Doyle splints (removed 1 week postoperatively)
8.structural fat grafting
Step 3: Marking
Step 4-5: Dissection
Step 6-7: Imbricate & Graft
Type II defect pre-op
3 weeks post-op: viable healthy mucosal grafts, intact sensation over clitoral remnant, pigmentation returning
Results
•we found an excellent improvement in contour, release of scar tissue, and labia minora reconstruction with a low complication rate
•post-operatively, patients have experienced a return in natural pigmentation, clitoral sensation, and sexual function
Conclusion
•here is a straightforward, effective approach that reconstructs lost tissue while improving the physical, sexual, and psychological health of FGM survivors
References
1.Female Genital Mutilation (FGM) Statistics - UNICEF Data. https://data.unicef.org/topic/child-protection/female-genital-mutilation/ #. Accessed 30 July 2023
2.Goldberg H, Stupp P, Okoroh E et al (2016) Female genital mutilation/cutting in the United States: Updated estimates of women and girls at risk, 2012. Public Health Rep 131:340–347. https://doi.org/10.1177/003335491613100218 - DOI - PubMed - PMC
3.Christopher AN, Othman S, Morris MP, Broach RB, Percec I. Clinical and Patient-Reported Outcomes of 19 Patients Undergoing Clitoral and Labial Reconstruction After Female Genital Mutilation/Cutting. Aesthetic Plast Surg. 2022;46(1):468-477. doi:10.1007/s00266-021-02648-y
