Flap Combination Phalloplasty in Female-to-Male Transsexuals.

Abstract

BACKGROUND:

Although phalloplasty with a free radial forearm (RF) flap is the gold standard for sex reassignment surgery in female-to-male transsexuals, it can result in unsightly scars, lymphedema, and numbness of the hand.

AIM:

To introduce the concept of flap combination phalloplasty and its clinical application.

METHODS:

This is a retrospective chart review study of patients undergoing phalloplasty using various multiple flaps. Demographic data, surgical data, and outcomes were recorded.

OUTCOMES:

Of the 15 cases, 5 were urethral fistulas; 4 were venous thrombosis; 2 were urethral calculus; and 1 was a partial flap loss.

RESULTS:

15 patients were included (age range 25-43 years, median 34 years). An RF flap and a deep inferior epigastric artery perforator flap combination were most frequently used. The median operative time for flap combination phalloplasty was 10.5 hours (range 6.5-12.5 hours). There was no total flap necrosis, but there was 1 case of partial flap loss. There were urethral fistulas in 5, venous thrombosis in 4, and urethral calculus in 2 cases.

CLINICAL IMPLICATIONS:

Flap combination phalloplasty will become the third option when both the RF flap and the anterolateral thigh pedicle flap are not useful.

STRENGTH & LIMITATIONS:

Flap combination phalloplasty is a complex operative procedure with a prolonged operative time, but it can provide more flap selection and reduce the morbidity at each donor site. Choosing from many different options can be beneficial to patients.

CONCLUSION:

Flap combination phalloplasty has a similar complication rate to other procedures and has advantages in terms of flexibility and less donor site morbidity; it may thus be an option when either the RF flap or the anterolateral thigh pedicle flap cannot be used. Namba Y, Watanabe T, Kimata Y. Flap Combination Phalloplasty in Female-to-Male Transsexuals. J Sex Med 2019;16:934-941.

• Authors: Yuzaburo Namba, Toshiyuki Watanabe, Yoshihiro Kimata
• Journal: The journal of sexual medicine (J Sex Med) Vol. 16 Issue 6 Pg. 934-941 (Jun 2019) ISSN: 1743-6109 [Electronic] Netherlands
• PMID: 30894300 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Cicatrix (etiology)
• Female
• Humans
• Male
• Penis (surgery)
• Postoperative Complications (etiology)
• Retrospective Studies
• Sex Reassignment Surgery (methods)
• Surgical Flaps
• Thigh (surgery)
• Transsexualism (surgery)
• Urethral Diseases (etiology)
• Urinary Fistula (etiology)