Phalloplasty for female transsexuals with sensate free forearm flap

Fang, Rong-Hwang; Lin, Jin-Teh; Ma, Shiuh

doi:10.1002/micr.1920150512

Cited by 65 publications

(71 citation statements)

References 15 publications

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“…30 catheter may be inserted in a subcutaneous tunnel extending from one meatal incision to the other. 10 Both these incisions are made in a triangular fashion, and the resulting triangular skin flaps are folded inward into the subcutaneous tunnel to prevent stenosis of the otherwise circular meatal scar (Fig. 1).…”

Section: Urethroplastymentioning

confidence: 99%

Fibula free flap phalloplasty: Modifications and recommendations

1996

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Radial forearm flap phalloplasty should be regarded as the gold standard. The large forearm donor site scar, however, has led to the search for other donor areas. We present our modifications and recommendations for addressing the ideal goals of phalloplasty better when applying the fibula free flap. We recommend preconstruction and secondary anastomosis of the neo-urethra. Preoperative infiltration of the cutaneous nerve is recommended for planning of the sensate flap. The osseous part of the flap should be long enough to be fixed to the tunica albuginea. We recommend a longitudinal, rather than a transverse, design for the flap. For aesthetic reasons, the flap should include two triangular tongues. Even so, secondary surgery will be needed. The patient may be left with functional loss in the donor region. A case report illustrates all of these points. We conclude that the sensate fibula free flap has a place in phalloplasty in case the patient refuses a forearm scar.

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Section: Urethroplastymentioning

confidence: 99%

Fibula free flap phalloplasty: Modifications and recommendations

1996

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“…Fistula formation is the most frequent complication, with reported incidence ranging from 40 to 100 percent. [1][2][3][4] Urethral stenoses are less frequent than urethrocutaneous fistulae, but represent a difficult problem. Biemer 4 reported on 14 transsexual patients with an incidence of strictures of 29 percent.…”

Section: Discussionmentioning

confidence: 99%

“…Flap success rates over 90 percent have been reported in a recent series. 1 Urethrocutaneous fistula is reported as the most common postoperative complication, with an incidence of 68 percent in the early series of Fang et al 2 Urethral stricture is less frequently reported, usually occurring at the junction of the native urethra and the neourethra. It is usually due to technical mistakes or vascular complications, and its treatment is difficult.…”

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confidence: 98%

Treatment of Urethral Stricture in a Female-to-Male Transsexual with a Tubulized Flap from the Labia Minora

Cavadas

Landín

2005

J reconstr Microsurg

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Urethral strictures are not uncommon after microvascular phalloplasty in female-to-male transsexuals, and usually are secondary to technical errors or vascular complications. A case of a female-to-male transsexual with recalcitrant urethral stricture after microvascular phalloplasty is reported. After one unsuccessful attempt at direct repair and a failed grafting procedure, a tubulized island flap from the remnants of the labia minora was successfully used to reconstruct the urethral stenosis. Current options for treatment of urethral stenoses in female-to-male transsexuals are discussed.

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“…The complication rate is relatively high, especially for urethral stenosis and formation of fistula [12]. Moreover, there is always a large scar in the donor area, with possible functional loss [13].…”

Section: Comparison With Other Methodsmentioning

confidence: 99%

Total sex‐reassignment surgery in female‐to‐male transsexuals: a one‐stage technique

Trombetta¹,

Liguori²,

Pascone

et al. 2002

BJU International

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IndicationsTheoretically, the ideal female-to-male sex reassignment surgery should be a one-stage procedure. The resulting neophallus should be cosmetically acceptable to both patient and partner, should have sufficient rigidity for vaginal penetration, and should maintain tactile sensitivity. Furthermore, scarring in the donor area should be minimized, and a neourethra constructed to allow voiding while standing [1].Although many patients would like to be able to use the phallus sexually and/or to void while standing, others only express a desire for a good cosmetic appearance to be accepted as males in society. Unfortunately, sex-reassignment surgery usually requires several operations, which are very invasive and time-consuming.Herein we present our recent experience with singlestage sex-reassignment surgery in female-to-male transsexuals, where mastectomy and chest contouring are carried out with oophorectomy and hysterectomy at the same time as the pedicled pubic phalloplasty. MethodsDuring the last 2 years three female-to-male transsexuals underwent one-stage sex-reassignment surgery in our departments. All patients had been cross-dressing, living as men and receiving testosterone for a long time. Before surgery each underwent a complete psycho-sexological evaluation. Hormonal therapy was discontinued 1 month before the intervention.Two operative teams are necessary; while the first team performs subcutaneous adenomammectomy and mastopexy using the round-block technique, hysterooophorectomy, phalloplasty and testicular prosthesis implantation are carried out by the second team (Fig. 1).The mastoplasty technique used in the one-stage procedure in these patients consists of subcutaneous adenomammectomy and mastopexy using the round-block technique (Fig. 2). Cutaneous excision depends upon the size and volume of the breast skin. A second round-block excision for a better aesthetic result is optional, but it is always undertaken when the breast is particularly big, and a large amount of skin removed. In some cases, a high degree of ptosis may require an inferior pedicle mastopexy technique, leaving only peri-areolar and inframammary fold scars [2].The phallus is fashioned from a flap of anterior abdominal wall skin, 10 ¥ 10 cm, measured from the base of the clitoris. Skin, subcutaneous fat and Scarpa's fascia are incised superiorly and laterally. Superficial inferior epigastric and external pudendal vessels are incorporated into the flap pedicle. After mobilization of the flap any excess subcutaneous tissue is excised to give better cosmesis. The abdominal design is then completed through skin excision. Through the same incision hysterectomy and bilateral salpingo-oophorectomy are easy. The abdominal fascia is closed, the umbilicus is incised and separated from the abdominal skin. Abdominal skin and subcutaneous fat are widely dissected from the abdominal wall (Fig. 3) up to the costal edge. The incision of the former umbilicus is closed and the neo-umbilicus repositioned 5 cm above the old one. The donor area...

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Phalloplasty for female transsexuals with sensate free forearm flap

Cited by 65 publications

References 15 publications

Fibula free flap phalloplasty: Modifications and recommendations

Fibula free flap phalloplasty: Modifications and recommendations

Treatment of Urethral Stricture in a Female-to-Male Transsexual with a Tubulized Flap from the Labia Minora

Total sex‐reassignment surgery in female‐to‐male transsexuals: a one‐stage technique

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