Anatomy of genital reaffirmation surgery (male-to-female): Vaginoplasty using penile skin graft with scrotal flaps.

Gender reaffirmation surgery is the final step in an individual's transition to their preferred gender. A clear understanding of the anatomy pertinent to this procedure is essential by the surgeon and patient. In male-to-female transgenders, female genitalia is constructed using the individual's penile skin to form the neovaginal canal and their scrotal skin folds post orchiectomy to create the labia majora. The surgical precursors of the remaining anatomical structures of the female genitalia are as follows: the clitoris is crafted from the glans penis and hence retains its innervation, the labia minora is formed using excess penile skin tissue, and the long male urethra is shortened to that of its feminine counterpart. The main goal of these reconstructive methods is to create a functionally and aesthetically acceptable vagina and vulva, as well as normal voiding function and satisfactory sexual function. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. Review of the relevant literature regarding the anatomy, procedure development, and outcomes is presented. Vaginoplasty utilizing penile skin grafts with scrotal flaps provides an aesthetically acceptable and psychologically satisfying results with normal voiding and sexual function. An advantage includes preserved erogenous sensation. Complications can arise, including chronic inflammation and fistula formation. The anatomy of vaginoplasty using penile skin grafts with scrotal flaps supports patients seeking male-to-female gender reaffirmation surgery. Clin. Anat. 31:140-144, 2018. © 2017 Wiley Periodicals, Inc.

The human occipital bone: review and update on its embryology and molecular development.

INTRODUCTION: The formation of the occipital bone is intricate and has been extensively studied with many controversial conclusions, but with minimal effort being focused on the genes and molecular interactions necessary for its formation. A better understanding of this bone of the calvarial and skull base may shed light on pathologies where the occiput is often considered the offending entity. METHODS: A review of the germane medical literature using textbooks and standard search engines was performed to gather information about previous conclusions as it pertains to the embryology and ossification of the occipital bone. RESULTS: The occipital bone has both membranous and cartilaginous origin with ossification occurring as early as week 9 of fetal gestation. Its formations is dependent on complex interacts between genes and molecules with pathologies resulting from disruption of this delicate process. CONCLUSION: There has been much controversy in the past in regards to the development and ossification process necessary for occipital bone formation, which has only recently been clarified with documentation of the genes and molecular interactions necessary for its formation. Lastly, this improved knowledge might improve our understanding of such congenital derailments as the Chiari malformations.