Two cases of tube-in-tube phalloplasty
using a free sensate RFF are described in which partial flap necrosis occurred involving the complete length of the neo-urethra and a strip of the outer lining of the neo-phallus. Neo-urethra-reconstruction was performed with a second RFF from the contralateral side providing well-vascularized tissue. No flap-related complications were observed. Twelve months postoperatively, both patients were able to void while standing. A satisfactory aesthetic appearance of the neo-phallus could be preserved with an excellent tactile and erogenous sensitivity. Using this technique, we successfully salvaged the neo-urethra and reconstructed the outer lining of the neo-phallus © 2013 Wiley Periodicals, Inc. Microsurgery 34:58–63, 2013. check details The free sensate radial forearm flap (RFF) is widely considered the standard technique for phalloplasty in female-to-male sex reassignment surgery. Different case series have confirmed its feasibility, reliability, and good aesthetic and functional results.[1-4] Major goals, namely the ability to urinate while standing and an appealing aesthetic
appearance with protective and erogenous sensitivity, may be reached in a one-stage procedure. The implantation of an erectile prosthesis for sexual intercourse is usually performed after protective sensitivity of the neo-phallus is regained GDC-0449 cost 6–12 months postoperatively. Possible complications comprise early and late anastomotic revisions due to venous, arterial, or combined thromboses, partial or total flap loss, and urological complications such as fistulas and strictures, which frequently require multiple urological revisions.[2, 6-9] Multiple designs for the RFF have been described, with the Chang-
and the Gottlieb-designs being the most frequently Phosphatidylinositol diacylglycerol-lyase used for tube-in-tube phalloplasty.[10, 11] Modifications, such as prelamination of the urethra using split-thickness skin grafts (STSG), full-thickness skin grafts (FTSG), or vaginal mucosa grafts have been performed.[8, 9, 12] We describe two cases of partial flap necrosis after free RFF-phalloplasty (Chang-design), which led to a full-length necrosis of the neo-urethra. For neo-urethra-reconstruction, we performed a second free RFF from the contralateral side in a modified Chang-design. Furthermore, we reviewed the literature for complications after RFF-phalloplasty. The patient was a 30-year-old female-to-male transsexual with a heavy smoking history. The mastectomy, laparoscopic-assisted hyster- and adnexectomy were already carried out. A simultaneous vaginectomy and free sensate RFF-phalloplasty from the left arm was performed according to the classic Chang-design. Microsurgical anastomoses were placed in the right groin with the radial artery onto the common femoral artery in an end-to-side fashion.