Fig. 2.

Surgical procedure.

(1) Before Z-plasty: mucosal tissue that was fused in a narrow ellipse from both labia majora was excised to create the central limbs of the “Z” (B-C(F-G). Next, incisions were made to create the lateral limbs of the “Z” (A-B(E-F) and C-D(G-H)). (2) After Z-plasty, the triangular tissue flaps were rotated and crossed over each other (from A-B-C-D(E-F-G-H) to B-A-D-C(F-E-H-G)). (3) Before Y-V plasty, a bow-shaped incision was made in the perineal skin (Fig. 2–3: bow-shaped dark skin-coloured part) to remove the scar tissue and generate an “inverted V-shaped” scar, with the apex near the posterior commissure. An incision was then extended from V's apex toward the ventral to generate an “inverted Y-shaped” wound. (4) After Y-V plasty: the flap was sutured with 3–0 absorbent sutures and reconstructed using an “inverted V-shape.”