Saving labium minus skin to treat possible urethral stenosis in female-to-male transsexuals

In our hands, neourethral stenosis is the main complication following metaidoioplasty in female-to-male transsexuals. We introduce the use of surplus of minor labial skin to correct these stenoses. The surplus was used as a subcutaneously pedicled flap with a 1.5 x 3.5 cm skin paddle to correct the circumferential deficit of neourethral lining at the level of the stenosis. After minimum undermining, the pedicle was retracted laterally to allow for a median external urethrotomy. The skin paddle was turned outside in to fit the resulting longitudinal neourethral defect. Subsequently, the major labial subcutis and skin were approximated in layers to cover the subcutaneous pedicled flap and to close the labioscrotum in the midline. Patients were kept immobilized for 3 days, and a suprapubic catheter was left open for 7 days. This technique was applied successfully in 15 of the 70 female-to-male transsexuals who consequently underwent metaidoioplasty in Amsterdam up to March of 1999. We conclude that the surplus of labial skin ought to be retained during primary surgery because it is an ideal substitute to correct neourethral stenosis.