Gender Affirming Revision Vaginoplasty Utilizing Decellularized Fish Skin Xenograft: Surgical Technique and Outcomes

Abstract

PURPOSE: Tissue availability for revision vaginoplasty in trans feminine individuals is often limited, creating challenges in cases with prior surgery or inadequate local tissue. While not yet extensively studied in genital reconstruction, Kerecis SurgiClose®, a decellularized fish skin xenograft, has shown promise as a skin substitute in other surgical contexts, including burn care and chronic wound management. This study aims to describe the surgical technique and evaluate the short-term clinical outcomes of revision vaginoplasty using decellularized fish skin xenograft (FSXRV) in trans feminine individuals. MATERIALS AND METHODS: A retrospective review of 27 trans feminine patients who underwent FSXRV between February 2023 and December 2024 was conducted. Data on preoperative characteristics, intraoperative details, and postoperative outcomes were collected from electronic medical records and analyzed. RESULTS: The median age was 36 years, and the median BMI was 27 kg/m². Median postoperative follow-up was 261 days. Indications for FSXRV included loss of neovaginal depth (81.5%), proximal introital narrowing (14.8%), and devitalized neovaginal grafts (3.7%). The xenograft was applied in various configurations and anatomical locations using either a perineal-only or combined perineal-robotic approach. No intraoperative or major (Clavien-Dindo ≥II) complications occurred within 30 days postoperatively. Five patients (18.5%) underwent subsequent canal revision after FSXRV. Positive outcomes were reported in 74% of patients using the Patient Global Impression of Improvement scale. CONCLUSION: Fish skin xenograft revision vaginoplasty demonstrated early safety and feasibility for revision neovaginal lining and appeared to reduce reliance on autologous grafts or flaps in complex revision settings.