Preoperative Planning of a Pedicled Anterolateral Thigh (ALT) Flap for Penile Reconstruction with the Multidetector CT Scan

Sinove, Y; Kyriopoulos, Eugenia; Ceulemans, Peter; Houtmeyers, Philippe; Hoebeke, Piet; Monstrey, Stan

doi:10.1055/s-0032-1333271

Cited by 35 publications

(12 citation statements)

References 9 publications

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“…Preoperative evaluation of ALT perforators and the subcutaneous fat tissue layer using CT angiography, may facilitate adequate patient and perforator selection, and determine a feasible flap size. (Sinove et al, ) Flap dimensions were marked preoperatively. To minimize surgery time, this procedure is ideally performed in three teams simultaneously, in which one team harvests the RFFF, one team the pedicled ALT and one team performs a scrotoplasty and pars fixa urethral lengthening.…”

Section: Methodsmentioning

confidence: 99%

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction

et al. 2017

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IntroductionRadial forearm free flap (RFFF) tube‐in‐tube phalloplasty is the most performed phalloplasty technique worldwide. The conspicuous donor‐site scar is a drawback for some transgender men. In search for techniques with less conspicuous donor‐sites, we performed a series of one‐stage pedicled anterolateral thigh flap (ALT) phalloplasties combined with RFFF urethral reconstruction. In this study, we aim to describe this technique and assess its surgical outcome in a series of transgender men.Patients and MethodsBetween January 2008 and December 2015, nineteen transgender men (median age 37, range 21–57) underwent pedicled ALT phalloplasty combined with RFFF urethral reconstruction in one stage. The surgical procedure was described. Patient demographics, surgical characteristics, intra‐ and postoperative complications, hospitalization length, and reoperations were recorded.ResultsThe size of the ALT flaps ranged from 12 × 12 to 15 × 13 cm, the size of the RFFFs from 14 × 3 to 17 × 3 cm. Median clinical follow‐up was 35 months (range 3–95). Total RFFF failure occurred in two patients, total ALT flap failure in one patient, and partial necrosis of the ALT flap in one patient. Long‐term urinary complications occurred in 10 (53%) patients, of which 9 concerned urethral strictures.ConclusionsIn experienced hands, one‐stage pedicled ALT phalloplasty combined with RFFF urethral reconstruction is a feasible alternative surgical option in eligible transgender men, who desire a less conspicuous forearm scar. Possible drawbacks comprise flap‐related complications, difficult inner flap monitoring and urethral complications.

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Section: Methodsmentioning

confidence: 99%

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction

et al. 2017

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“…Accepted slang term for gender-affirming chest surgery procedure, an intrapenile prosthetic erectile device is similarly placed after the primary reconstruction is performed, per individual patient preferences. The radial forearm flap is the most common donor site; however this leaves a large scar on the forearm, and therefore other donor sites including the anterolateral thigh and abdomen may be preferred [10]. A metoidioplasty is a procedure that uses the patient's natal tissue, which has hypertrophied in response to testosterone to create a penis.…”

Section: Gender Dysphoriamentioning

confidence: 99%

Spectrum of imaging findings in gender-affirming genital surgery: Intraoperative photographs, normal post-operative anatomy, and common complications

et al. 2021

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“…The number of transgender women who undergo vaginoplasty is increasing. Fifty-eight percent of transgender women surveyed in the Pelvic and thigh CT angiography (27): supine position, remove underwear, use breath hold, z-axis coverage from knee to umbilicus 100 mL iodinated contrast material, 4.5-mL/sec injection followed with a 45-mL saline solution flush 120 kVp, 200 mAs, 0.5-sec gantry rotation, 0.6-mm table feed 3D and MIP reconstructions Report Cartesian coordinates Report perforator size and distance from the anterior superior iliac spine and lateral patella, presence of arteries and veins, branching pattern Pedicle length, continuity, and anatomic variation Thickness of subcutaneous tissue Suspected neourethral stricture, leak, or fistula…”

Section: Vaginoplastymentioning

confidence: 99%

“…CT angiography may be used in the preoperative evaluation of perforating arteries and flap size before surgery (Table 3) (27). A Cartesian coordinate system is created using the anterior superior iliac spine and lateral patella as cranial and caudal reference points.…”

Section: Phalloplastymentioning

confidence: 99%

“…Perforating arter-ies arising from the femoral vessels pierce the fascia and pass through deep tissues to the skin and subcutaneous tissues. Preference is given to broad perforators with mediolateral and craniocaudal branching patterns (27). Postoperative CT features of ALT flap phalloplasty include surgical clips about the femoral vessels and enhancement of the neophallus vasculature (Fig 17).…”

Section: Phalloplastymentioning

confidence: 99%

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Imaging Findings in Transgender Patients after Gender-affirming Surgery

Stowell¹,

Grimstad²,

Kirkpatrick³

et al. 2019

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Gender-affirming surgeries expand the options for physical transition among transgender patients, those whose gender identity is incongruent with the sex assigned to them at birth. Growing medical insight, increasing public acceptance, and expanding insurance coverage have improved the access to and increased the demand for gender-affirming surgeries in the United States. Procedures for transgender women, those patients with feminine gender identity, include breast augmentation using implants and genital reconstruction with vaginoplasty. Some transgender women receive medically unapproved silicone injections for breast augmentation or other softtissue contouring procedures that can lead to disfigurement, silicone pulmonary embolism, systemic reactions, and even death. MRI is preferred over CT for postvaginoplasty evaluation given its superior tissue contrast resolution. Procedures for transgender men, patients with a masculine gender identity, include chest masculinization (mastectomy) and genital reconstruction (phalloplasty or metoidioplasty, scrotoplasty, and erectile device implantation). Urethrography is the standard imaging modality performed to evaluate neourethral patency and other complications, such as leaks and fistulas. Despite a sizeable growth in the surgical literature about gender-affirming surgeries and their outcomes, detailed descriptions of the imaging features following these surgeries remain sparse. Radiologists must be aware of the wide variety of anatomic and pathologic changes unique to patients who undergo gender-affirming surgeries to ensure accurate imaging interpretation.

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Preoperative Planning of a Pedicled Anterolateral Thigh (ALT) Flap for Penile Reconstruction with the Multidetector CT Scan

Abstract: Preoperative evaluation of ALT perforators and the subcutaneous fat tissue layer is feasible with an MDCT scan and provides precise data to make an adequate patient and perforator selection and determine the exact flap size.

Cited by 35 publications

References 9 publications

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction

Spectrum of imaging findings in gender-affirming genital surgery: Intraoperative photographs, normal post-operative anatomy, and common complications

Imaging Findings in Transgender Patients after Gender-affirming Surgery

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