JOURNAL OF GYNECOLOGIC SURGERY © Mary Ann Liebert, Inc. The Use of Z-Plasty in the Treatment of Vaginal Septum MEHMET BEKERECIOGLU, M.D., 1 OZCAN BALAT, M.D., 2 MUSTAFA TERCAN, M.D., 1 IRFAN KUTLAR, M.D., 2 and BEKIR ATIK, M.D. 1 ABSTRACT A transverse vaginal septum is probably less common than congenital absence of the vagina and uterus. It has been diagnosed in newborns, infants, and older adolescent girls. Trans- verse vaginal septum varies in thickness and can be located at almost any level in the vagina but most often is located in the upper vagina. It is associated with few urologic or other anomalies and can lead to serious problems and symptoms. The diagnosis is made by clini- cal findings and radiologic evaluation. The treatment consists of simple excision, Z-plasty techniques, and various flaps. Two cases of transverse vaginal septum are reported here. In case 1 it is located in the upper vagina; in case 2, in the lower vagina. To eliminate the sep- tum, Z-plasty was used to minimize the raw surface of the vagina. The remaining part of the raw surface in case 1 was covered with split thickness skin graft with fibrin glue. (J GY- NECOL SURG 18:81) INTRODUCTION A NOMALIES OF THE MÜLLERIAN DUCTS are unusual gynecologic problems. 1 Anomalies are grouped ac- cording to similarities of clinical manifestations, treatment, and prognosis for fetal salvage. 2 A trans- verse vaginal septum (TVS) can develop at any location in the vagina but is most commonly found in the upper vagina at the point of junction between the vaginal plate and the caudal end of the fused müllerian duct. 1,3 Treatment of TVS with simple excision can lead to stricture formation similar to a ring. In order to prevent this late complication, we used flaps to prepare the vaginal and glandular surfaces. CASE REPORTS Case 1 The patient was 14 years old and single. She reported cyclic lower abdominal pain for 6 months and no visible menstrual discharge. There was no hymen or vaginal opening. Tenderness located on her lower ab- domen was not related any abdominal mass. The uterus was antevert and in an anteflex position and mea- sured 65 3 47 mm in diameter. There was a hypodense area, 35 3 60 mm (hematocolpos) in diameter in the uterus as observed by ultrasound evaluation. The ovaries were normal bilaterally. In the vagina, there was also a hypodense area that extended 100 3 70 mm. Via physical examinations and radiologic evalua- tion, the diagnosis was an upper TVS with lower vaginal agenesis. Chromosome analysis and intravenous pyelography yielded normal results. There were no associated anomalies. Under general anesthesia, in the lithotomy position, two crossing “lazy S” incisions were made on the vault of the short vagina. There was a thick transverse septum located at the upper one third of the vagina. An organized hematoma of approx- 81 1 Department of Plastic and Reconstructive Surgery, Gaziantep University, School of Medicine, Gaziantep, Turkey. 2 Department of Obstetrics and Gynecology, Gaziantep University, School of Medicine, Gaziantep, Turkey. Original Articles