By T. Ines. Lutheran Bible Institute.
Though all surgeries are surgeon dependent purchase 250mg cipro, this operation is less reproducible than the wedge technique because it requires more artistic aptitude purchase 250mg cipro visa. There are multiple skin folds that need to be excised, reduced, and brought together to achieve a natural anatomic appearance of the entire external vulvar region. The edges should be contoured or removed in an artistic fashion instead of the commonly described term amputation. The term amputation seems to insinuate the protruding labia should just be “cut off” in a straight vertical fashion, which does not result in aesthetically pleasing results and can cause pain and discomfort. Time and care should be put into the incision and the excision of the protruding aspect of the labia. It should be removed in a curvilinear fashion at the level or below the level of the labia majora. The amount of tissue removed should be in direct correlation to the patient’s desire. Aggressive excision can result in complete amputation resulting in an undesirable result (Figure 116. The results of a contouring surgery should be aesthetically pleasing yet address any associated physical dysfunction. Most women state that they do not want their labia minora to protrude beyond the majora and are interested in a smooth, sleek appearance of the external vulva. This was confirmed in a recent study of 550 women who presented for labial reduction surgery at our specialty center in Atlanta. The technique was first described in the literature by Alters in 1998, where he utilized the technique on four patients . In this case series, it is suggested that excision or contouring the protuberant edges removes the natural contour and color. Interestingly, many patients do not feel that the darkened skin edges are a normal color but instead the result of aging and hormonal changes. This is no different than the skin discoloration that happens on hands or the areola of the breast. This 1744 was also confirmed in a recent study of 550 women presenting for labiaplasty at our center in Atlanta.
The urethral defects in these patients were repaired with human bladder acellular collagen matrices  purchase cipro 250mg with mastercard. The neourethral tissue was created by anastomosing the matrix to the urethral plate in an onlay fashion order cipro 1000 mg fast delivery. After a 3-year follow-up, three of the four patients had a successful outcome in regard to cosmetic appearance and function. One patient who had a 15 cm neourethra created developed a subglandular fistula (Figure 27. Another study in 30 patients with recurrent stricture disease showed that a healthy urethral bed (two or fewer prior urethral surgeries) was needed for successful urethral reconstruction using the acellular collagen-based grafts . More than 200 pediatric and adult patients with urethral disease have been successfully treated in an onlay manner with a bladder-derived collagen-based matrix. One advantage of this matrix over the traditional nongenital tissue grafts that have been used for urethroplasty is that the matrix material is “off the shelf. Strictured tissue is excised, preserving the urethral plate on left side and matrix is anastomosed to urethral plate in an onlay fashion on right side. Cystoscopic view of urethra preoperatively on left side and 4 months after repair on right side (d). However, further study indicated that when tubularized urethral repairs with unseeded matrices were attempted experimentally, adequate urethral tissue regeneration was not achieved, and complications such as graft contracture and stricture formation occurred . To determine if seeding the matrix with cells from the urinary tract could improve the results of tubularized urethral repairs, autologous rabbit bladder epithelial and smooth muscle cells were grown and seeded onto preconfigured tubular matrices. Entire urethral segments were then resected and urethroplasties were performed with tubularized collagen matrices either seeded with cells or without cells. The tubularized collagen matrices seeded with autologous cells formed new tissue that was histologically similar to native urethra.