Glans sculpting in phalloplasty — experiences in female-to-male transsexuals

Fang, Rong-Hwang; Kao, Yi-Sheng; Ma, Shiuh; Lin, Jin-Teh

doi:10.1054/bjps.1997.0220

Cited by 20 publications

(4 citation statements)

References 11 publications

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“…Generally, an aesthetically acceptable glans should have a relatively prominent coronal ridge and a retroglanular coronal sulcus. 2 , 3 Over the past few decades, many procedures and techniques for glans sculpting have been devised in an attempt to create this optimal glans, although most of the procedures are a variant of the Norfolk technique, where a distal skin flap is raised and sewn in place using mattressed sutures.…”

Section: Discussionmentioning

confidence: 99%

“…An incision is made at the appropriate point at the distal phallus and the distal phallus skin flap developed as the gland ridge, as described in most glansplasty techniques. [1][2][3][4] A 100% medical-grade silicone carving block is used to create a hand-carved glans ridge implant of the correct length, tapered at both ends. It is generally 5 × 5 mm in maximum thickness and triangular in cross section (Fig.…”

Section: Surgical Techniquementioning

confidence: 99%

“…2 One major complication of the technique is flattening of the coronal ridge. 3 At our center, patients with glans ridge flattening are offered redo/revision glansplasty, in which the original incision is reincised and the flap refolded, usually without additional skin graft placement. Because this procedure, too, can periodically fail, we developed a novel procedure that requires a hand-carved, solid silicone implant to be placed under the ridge in an attempt to increase its prominence.…”

Section: Introductionmentioning

confidence: 99%

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High Surgical Complication Rates after Silicone Implant Use for Improvement of Glans Ridge Appearance

Reddy

Crane²,

Safir³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Construction of the glans is an important aspect of gender-affirming phalloplasty. In these surgeries, the glans ridge is commonly constructed using the Norfolk technique or a similar technique. In cases of glans ridge flattening after creation, we generally recommend a redo/revision glansplasty, which is often curative. However, in situations when the glans ridge flattens again, we developed a silicone glans implant technique in an effort to create a satisfactory and lasting glans ridge. Methods: We conducted a pilot study of our first 12 glans implant cases. A retrospective chart review and brief, ad-hoc patient survey measured patient demographics, implant status, and patient satisfaction. Results: A total of 12 patients received a silicone glans implant between November 2017 and February 2020. One patient had the glans implant removed before the survey, and also could not be contacted. Three patients did not respond to the survey. Of the eight patients who responded, only five (5/8, 63%) patients still had the silicone implant at the time of the survey. The average satisfaction score was 3.25 (range 1 = very satisfied and 5 = very dissatisfied). Common complaints cited included dissatisfaction with implant appearance, as well as infection, discomfort, and pain. Conclusions: Patients and surgeons should be aware of the possibility of a novel silicone implant technique to create a glansplasty in those with failed/flattened previous glansplasty surgery. However, the technique is in development: patient satisfaction remains spotty and complication rates are high, although technical improvements may increase future success rates.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

High Surgical Complication Rates after Silicone Implant Use for Improvement of Glans Ridge Appearance

Reddy

Crane²,

Safir³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…[58] Split-thickness skin graft produces a more normal-looking coronal sulcus than full-thickness skin graft. [59] It has been regarded as a technique of coronal ridge and sulcus construction that has the best results[6059] [Figure 6]. …”

Section: Glansplastymentioning

confidence: 99%

Phalloplasty: The dream and the reality

Rashid

Tamimy

2013

Indian J Plast Surg

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Phalloplasty has come a long way as Plastic Surgery has evolved over the years. The complication ridden multistage tube pedicles popularized by Gillis were, with the advent of microsurgery, replaced by radial forearm flaps. The composite osteo-cutaneous version of this flap promised ‘All for one and one for all’ assuring both a reliable urinary conduit and a phallus stiffener. Prelamination and prefabrication to make the neo-urethra came with the promise of reducing both fistula and strictures but that did not happen and flap failure rates increased. Penile stiffeners of various types have been introduced; the artificial ones were associated with high infection and failure rates and are best inserted after the neo-penis regains some sensitivity. With the introduction of perforator flaps the Anterolateral thigh flap in its sensate pedicled form has started replacing the Radial forearm free flap as the first choice flap because of a hidden donor area and lack of microsurgical expertise requirement. Being sensate it tolerates a stiffener better. It is now possible to reconstruct an aesthetically pleasing glans as well, thus meeting both the aesthetic and functional desires of the patient. Complications encountered in this reconstructive effort include flap failure, urethral fistula, urethral stricture and stiffener related problems.

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Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

et al. 2023

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ImportanceGender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy.ObjectiveTo identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation.Evidence ReviewIn this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080).FindingsIn total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate.Conclusions and RelevanceIn this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.

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Glans sculpting in phalloplasty — experiences in female-to-male transsexuals

Cited by 20 publications

References 11 publications

High Surgical Complication Rates after Silicone Implant Use for Improvement of Glans Ridge Appearance

High Surgical Complication Rates after Silicone Implant Use for Improvement of Glans Ridge Appearance

Phalloplasty: The dream and the reality

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

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