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After Care of Female to Male Sex Reassignment Surgery (FTM SRS)
Stages 2.1 & 2.2
(Vaginectomy and Urethral Prefabrication)
The 2nd stage of FTM surgery consists of two operations:
| 2.1 |
Vaginectomy with Urethral Lengthening. |
| 2.2 |
Urethral Prefabrication in the patient’s forearm by using gluteal skin. |
Post-Operative Instructions for FTM Stage 2.1
| 1. |
After surgery, a drainage tube is inserted inside the patient’s vagina, and the wound suture is well dressed. A urine catheter is also inserted in order to protect the surgical wound from being contaminated. The surgeon will examine the area around the surgical wound and the drainage tube to see if any blood is oozing from the vagina, if not then the drain can be removed. Normally the drain is inserted for around 4-5 days. |
| 2. |
A urine catheter is provided to protect the surgical wound from being contaminated by urine. Normally the wound should be protected from water exposure for 5-7 days. Therefore the urine catheter can be removed within 6-7 days. The patient can urinate as normal afterwards. |
| 3. |
Initially after removing the urine catheter, the patient may experience some difficulties whilst passing urine, the wound may bleed, and also soreness may persist at the surgical wound site. These symptoms generally last for 1-2 weeks after which the wound will be healed and stop bleeding. It is important that the patient keeps the wound clean by wiping it with a wet cotton ball and applying an antibiotic ointment, to prevent infection, every time after going to the toilet. |
| 4. |
Dissolvable sutures are used which will come out on their own within 4-6 weeks after the surgery. Also they can be removed at the hospital 2-3 weeks after surgery if the wounds heal well enough. |
Post-Operative Instructions for FTM Stage 2.2
| 1. |
A rubber catheter wrapped with the skin will has been inserted into the patient’s arm during surgery. It may be recovered within 2-3 weeks. The patient should regularly clean the wound and the neo-urethra twice a day – in the morning after waking up and in the evening before going to bed. Clean the neo-inner urethra thoroughly with salt water and insert a urine catheter into it in order to avoid constriction of the neo-urethra. |
| 2. |
While the wound is healing, there may be some dead skin peeling off from the neo-urethra, especially after cleaning it with water. Gradually the neo-inner urethra skin will slowly change its skin color to pink when the wound is fully healed. So the patient does not need to be concerned about black skin protruding from the urethra. |
| 3. |
In the first month, the tube made from urine catheter which inserted into the arm should be cleaned by boiling water for about 1 minute. Then the patient should leave it to dry, and keep it in a clean box for use next time. After the wound is completely healed or after 1 month, you can clean the tube with just shower gel while you are having a shower, and dry it with a clean towel. |
| 4. |
Using lubricating gel helps to insert the tube more comfortably. However it should be used only when the wound is fully healed. The tube should be cleaned during the day if there is a lot of body sweat. |
| 5. |
The material used for stitching during surgery is an absorbable suture which will come out on it own after the wound is healed or about 4 weeks after the surgery. If you see that the thread is coming out, you can cut the thread with clean scissors and clean the wound as normal. |
| 6. |
In some cases, the wound in the urethra may be severely inflamed whilst recovering. If this is the case it should be looked at by the surgeon. Antibiotic should be regularly administered to control the infection and to protect the tissue from damage. If there is any problem please contact the coordination nurse through any contact channels provided by the hospital, i.e. telephone, email, agency representative, etc. |
| 7. |
The donor wound around the lower hip is traumatized from having skin removed to make the neo-urethra in the arm. Normally the wound is stitched with surgical staple by the surgeon. The wound will be completely healed within 2 weeks and then the wire will be removed by the surgeon. During the first few months, the patient should avoid any activities which may cause skin tension, such as, strenuous exercise, riding a bicycle, etc. Otherwise the wound may be torn open. |
| 8. |
The scar on the hip may developed a nasty keloid which is caused by skin tension in the area of the wound in the early stages of healing. However, it should subside and become softer within 3-6 months. Eventually only stitch marks should show which will be hidden whilst wearing shorts. |
If there is any unusual scar appearance, the patient can have it examined and corrected after the wound is completely recovered. Once fully healed, the surgeon will consider an individual patient’s scar condition with a view to correcting each scar as much as possible.
If you have any further questions, please do not hesitate to inform your nurse or surgeon in order to assist us to provide you with appropriate and effective post operative care.
PLASTIC AND RECONSTRUCTIVE SURGERY DEPARTMENT
Yanhee International Hospital
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