Phalloplasty: techniques and outcomes

Abstract

Phalloplasty is an exceptionally complicated reconstructive procedure that attempts to create a structure that is penis-like. As patient goals vary widely, it is helpful to think about phalloplasty as a modular set of procedures that can be combined, mixed and matched to meet the needs of each individual patient while also taking into account their anatomy. Each module-but particularly the shaft and penile urethracan be performed using a variety of techniques. To date, there is no consensus among surgeons regarding the optimum staging of the reconstructive steps. Our primary goal is to outline the most frequently performed and reported options in phallic reconstruction and outline the various considerations that go into choosing a given sequence of procedures for the specific patient. The secondary goal of this article is to describe the complications common to each of those modules and how they interact when combined.

Partial flap loss in transgender phalloplasty using the anterolateral thigh or forearm - a systematic literature review

“…An example of partial flap loss in radial forearm free flap phalloplasty at the distal radial aspect of the flap. A: debridement of the flap and placement of Integra (Integra, Princeton, NJ); B: status post full thickness skin graft (FTSG); C: healed appearance following FTSG [34,35] A C B Figure 6. Appearance at the second stage of a Big Ben style two-stage phalloplasty.…”

“…Appearance at the second stage of a Big Ben style two-stage phalloplasty. Note the marsupialized pars pendulans urethra [33,34] Figure 7. Example of partial flap loss of the proximal urethral extension in an anterolateral thigh flap phalloplasty.…”

“…We then utilized this information to inform a discussion on the current literature and outline future directions regarding risk mitigation and the management of PFL following phalloplasty for the treatment of gender dysphoria. Result after antero-lateral thigh flap phalloplasty [33,34]…”

Phalloplasty: understanding the chaos

“…The large cutaneous surface area of the male phallus dictates the use of a large cutaneous flap for phallic construction. In the past, random-pattern cutaneous flaps were most commonly used, but axial pedicled or microvascular free flaps dominate at present [29][30][31] . The free radial forearm flap (RFFF) and the anterolateral thigh pedicled or free flap (ALT) are, by a considerable margin, the most common donor site choices currently.…”

“…Regardless, most surgeons performing gender confirming phalloplasties consider the RFFF to be the best flap donor site at the present time. Radial forearm free flap (RFFF) [31] . A-B: tube-in-a-tube.…”