Novosti
Khirurgii

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Year 2019 Vol. 27 No 5

PEDIATRIC SURGERY

D.A. MOROZOV1, E.K. AYRYAN1, E.N. TCMOKALUK2, K.D. MOROZOV1, Z.F. SATAEVA1

CLITOROPLASTY WITH MORPHOLOGY OF THE GLANS SENSITIVE ZONES IN CHILDREN WITH DISORDERS OF SEX DEVELOPMENT

I.M. Sechenov First Moscow State Medical University1,
A.I. Evdokimov Moscow State University of Medicine and Dentistry 2, Moscow,
The Russian Federation

Objective. Òo improve the results of feminizing plastics of the external genital organs in children with disorders of sex development.
Methods. 114 patients were operated on from the period of 1998 to 2017. The two-stage correction of the genitals was performed in the majority – 108 patients (94%). 79 (69%) children underwent feminizing plastic surgery according to A.B. Okulov, the feminizing plastic with preservation of the dorsal vascular-neural bundle was done in 35 (31%) patients. Among the patients of this group, in 29 (25%) the removal of excess tissues of the clitoral glans along the lateral surfaces and in 6 (5%) along the ventral surface was performed. Control examination of patients after plastic was performed on the 10th, 30th, 60th, 90th, 180th, 360th day, the appearance of the genitals was assessed for feminine type and clitoral reperfusion timing. 18 patients (15%) underwent the morphological examination of the resected sections of the clitoral glans. Morphological studies of 25 samples of full-layer sections of the clitoris glans were performed: 14 lateral, 6 ventral and 5 dorsal fragments.
Results. Evaluation of cosmetic results in the early and long-term after surgery did not show significant differences, regardless of the method of clitoroplasty. Reperfusion timing in the group where the plastic was performed according to A.B. Okulov was higher in comparison with the groups with the preservation of the dorsal vascular-neural bundle 3.8 sec. (3; 4.4)/ 2.5 sec. (1.9; 3.1) (ð=0.003). During microscopy it was revealed that the head of the clitoris is rich in nerve trunks and tactile bodies, which are located mainly on the ventral and dorsal areas of the glans of the clitoris. The innervation of the skin of the lateral sections of the clitoris glans is due to small nerve endings without sensitive bodies.
Conclusions. While carrying out clitoroplasty, preference should be given to the methods with preservation of the dorsal vascular-neural bundle. When the glans is resected, the ventral and dorsal surfaces of the organ should be preserved.

Keywords: clitoroplasty, resection of the clitoris glans, feminizing plastics, virilization, disorders of sex development
p. 541-552 of the original issue
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Address for correspondence:
119991, The Russian Federation,
Moscow, Trubetskaya Str., 8-2,
I.M. Sechenov First Moscow
State Medical University,
Department of Pediatric Surgery
and Urology-Andrology.
Tel. +7-968-067-18-95,
e-mail: edikayryan@mail.ru,
Eduard K. Ayryan
Information about the authors:
Morozov Dmitry A., MD, Professor, Head of the Department of Pediatric Surgery and Urology-Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1940-1395
Ayryan Eduard K., Assistant of the Department of Pediatric Surgery and Urology-Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8267-0205
Tcmokaluk Elena N., Assistant of the Pathologic Anatomy Department, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
https://orcid.org/0000-0003-2722-6096
Morozov Kirill D., Student of the Educational Program «Medicine of the Future», I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-6300-1102
Sataeva Zifa F., Student of the Pediatric Faculty, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-3780-577X
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