ABSTRACT
The radial forearm flap remains the preferred technique for phalloplasty. From 1999 to 2009, 19 patients with primary female transsexualism underwent gender reassignment surgery at our center. The radial forearm flap phalloplasty is modified as a two-stage procedure, with prelamination of the neourethra on the donor forearm before microsurgical transfer 3 months later. At 5-year follow-up, patients were asked to complete a survey on the functional, aesthetic, and psychological results postsurgery. The radial forearm flap reliably provided sufficient bulk with stiffness for the neophallus with acceptable aesthetic appearance. We further describe technical modifications to reduce the rate of urethral strictures and fistulas. None of the patients regretted undergoing gender transformation. Patients are satisfied with the surgical result and generally prepared to accept its potential costs, in view of the significant psychological and legal benefits.
KEYWORDS
Phalloplasty - transsexual - radial forearm flap
REFERENCES
-
1
Gilbert D A, Horton C E, Terzis J K, Devine Jr C J, Winslow B H, Devine P C.
New concepts in phallic reconstruction.
Ann Plast Surg.
1987;
18
128-136
-
2
Benelli L.
A new periareolar mammaplasty: the “round block” technique.
Aesthetic Plast Surg.
1990;
14
93-100
-
3
Chang T S, Hwang W Y.
Forearm flap in one-stage reconstruction of the penis.
Plast Reconstr Surg.
1984;
74
251-258
-
4
Hage J J, Bouman F G, de Graaf F H, Bloem J J.
Construction of the neophallus in female-to-male transsexuals: the Amsterdam experience.
J Urol.
1993;
149
1463-1468
-
5
Fang R H, Lin J T, Ma S.
Phalloplasty for female transsexuals with sensate free forearm flap.
Microsurgery.
1994;
15
349-352
-
6
Fang R H, Kao Y S, Ma S, Lin J T.
Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases.
Br J Plast Surg.
1999;
52
217-222
-
7
Byun J S, Cho B C, Baik B S.
Results of one-stage penile reconstruction using an innervated radial osteocutaneous flap.
J Reconstr Microsurg.
1994;
10
321-331
-
8
García de Alba A, de la Peña-Salcedo J A, López-Monjardin H, Clifton J F, Palacio-López E.
Microsurgical penile reconstruction with a sensitive radial forearm free flap.
Microsurgery.
2000;
20
181-185
-
9
Vesely J, Hyza P, Ranno R et al..
New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals.
Ann Plast Surg.
2007;
58
544-550
-
10
Lin C T, Chen L W.
Using a free thoracodorsal artery perforator flap for phallic reconstruction—a report of surgical technique.
J Plast Reconstr Aesthet Surg.
2009;
62
402-408
-
11
Rubino C, Figus A, Dessy L A et al..
Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals.
J Plast Reconstr Aesthet Surg.
2009;
62
e45-e49
-
12
Biemer E.
Penile construction by the radial arm flap.
Clin Plast Surg.
1988;
15
425-430
-
13
Gottlieb L J, Levine L A.
A new design for the radial forearm free-flap phallic construction.
Plast Reconstr Surg.
1993;
92
276-283
discussion 284
-
14
Matti B A, Matthews R N, Davies D M.
Phalloplasty using the free radial forearm flap.
Br J Plast Surg.
1988;
41
160-164
-
15
Semple J L, Boyd J B, Farrow G A, Robinette M A.
The “cricket bat” flap: a one-stage free forearm flap phalloplasty.
Plast Reconstr Surg.
1991;
88
514-519
-
16
Gilbert D A, Jordan G H, Devine Jr C J, Winslow B H.
Microsurgical forearm “cricket bat-transformer” phalloplasty.
Plast Reconstr Surg.
1992;
90
711-716
-
17
Garaffa G, Christopher N A, Ralph D J.
Total phallic reconstruction in female-to-male transsexuals.
Eur Urol.
2009;
57
715-722
-
18
Leriche A, Timsit M O, Morel-Journel N, Bouillot A, Dembele D, Ruffion A.
Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism.
BJU Int.
2008;
101
1297-1300
-
19
Monstrey S, Hoebeke P, Selvaggi G et al..
Penile reconstruction: is the radial forearm flap really the standard technique?.
Plast Reconstr Surg.
2009;
124
510-518
-
20
Kim S K, Lee K C, Kwon Y S, Cha B H.
Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals.
J Plast Reconstr Aesthet Surg.
2009;
62
309-317
-
21
Mutaf M.
A new surgical procedure for phallic reconstruction: Istanbul flap.
Plast Reconstr Surg.
2000;
105
1361-1370
-
22
Koshima I, Inagawa K, Okuyama N, Moriguchi T.
Free vascularized appendix transfer for reconstruction of penile urethras with severe fibrosis.
Plast Reconstr Surg.
1999;
103
964-969
-
23
Khouri R K, Young V L, Casoli V M.
Long-term results of total penile reconstruction with a prefabricated lateral arm free flap.
J Urol.
1998;
160
383-388
-
24
Capelouto C C, Orgill D P, Loughlin K R.
Complete phalloplasty with a prelaminated osteocutaneous fibula flap.
J Urol.
1997;
158
2238-2239
-
25
Levine L A, Elterman L.
Urethroplasty following total phallic reconstruction.
J Urol.
1998;
160
378-382
-
26
Sengezer M, Oztürk S, Deveci M, Odabaşi Z.
Long-term follow-up of total penile reconstruction with sensate osteocutaneous free fibula flap in 18 biological male patients.
Plast Reconstr Surg.
2004;
114
439-450
discussion 451-452
-
27
Selvaggi G, Monstrey S, Hoebeke P et al..
Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder.
Plast Reconstr Surg.
2006;
118
1171-1177
-
28
Hage J J, Bout C A, Bloem J J, Megens J A.
Phalloplasty in female-to-male transsexuals: what do our patients ask for?.
Ann Plast Surg.
1993;
30
323-326
Colin SongM.D.
Plastic Reconstructive & Aesthetic Surgery, Singapore General Hospital
Outram Rd, Singapore 169608
Email: colin.song@sgh.com.sg
