iDentistry The Journal identistry_may_aug2019 | Page 20

The Journal
retain the roughness for skin attachment (Fig 2).
The whole of the wax pattern with the cylinder of
die stone inside was invested in a flask (Fig 1b).
The pattern was fabricated just upto the level of
base of the brass flask so as to allow for easy
opening of the mould created. The flask was
dewaxed and the cylinder of diestone got
attached to the plaster at the ends which
resulted in desired hollowing of the stent. The
diestone cylinder is coated with separating
alginate based media to allow for easy retrieval
of the stent (Fig 1c). The flask was packed with
the heat cure acrylic resin and was cured in the
curing unit. The vaginal stent so retrieved after
deflasking was finished but not polished to
retain the roughness for skin attachment (Fig 2)
was wrapped all around the stent (Fig 2a). The
labia minora were sutured with two transverse
vulval sutures to keep the stent in position and
retain in neovagina (Fig 2b). Malecot’s catheter
was inserted in the lumen of stent for assisting
in drainage.
Preparation of vaginal stent with skin graft
Fig:3
Fig:2. Vaginal Stent
Surgical Procedure
The stent so procured was cold sterilised in a
betadine solution overnight. The patient was
planned for neovagina through McIndoe
vaginoplasty. Urinary catheter (Foley) was
inserted at the beginning of procedure. Stay
sutures were taken to retract labia and improve
visibility. Abdomino perinneal approach was
utilised to drain the clotted blood in the blind
uterine cavity. Continuous uterine drainage was
established using Malecot's rubber drain. The
split thickness skin graft was harvested from the
medial aspect of thigh. The skin graft was
secured to the stent through the sutures and
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Post-operatively, the patient needed
catheterisation till first dressing change.
Dressing was done after 12 days under spinal
anaesthesia. Perineal area was regularly
checked for any bleeding, discharge, position of
stent and any cutting through of the vulval
sutures. After 1 week, labial sutures were
removed and the vaginal stent was taken out
gently. Follow-up was done every fortnight for 6
months. The patient was trained to use the
acrylic stent and further recovery was
uneventful. Post-insertion instructions
regarding use of vaginal stent, maintenance,
and daily cleaning were given. The patient was
advised to use acrylic stent continuously for 3
months and then during night time for the next 3
months. Compliance for the use of stent was
satisfactory. No complication was observed and
the patient and her parents were satisfied with
the treatment outcome.
Vol. 15
No. 2
May-Aug 2019