A new phalloplasty technique: the free anterolateral thigh flap phalloplasty

https://doi.org/10.1016/j.bjps.2005.05.016Get rights and content

Summary

After a 10-year experience with phalloplasty in female to male gender reassignment surgery and with more than one hundred cases treated, we have introduced a new technique for creation of the neo-phallus. Between 1993 and 2002, phalloplasties were performed in our department using the free radial forearm flap or the pre-expanded suprapubic flap (modified Pryor technique). The study of long-term results and complications of these cases, as well as patient requests for a new donor site, induced us to look for an alternative flap for phalloplasty. The versatility and the low donor site morbidity of anterolateral thigh flap persuaded us to use it for phalloplasty.

Since March 2003, six phalloplasties with free anterolateral thigh (ALT) flap have been performed. The results have been encouraging. The shape and the consistency of the neo-phallus are suitable, the flap can be sensate and an erectile prosthesis can easily be implanted. Penile urethral reconstruction is possible in the same operative stage. Patient satisfaction is high.

The anatomy and harvesting techniques of ALT flap have already been exhaustively described by several authors and only the operative technique of phalloplasty with free ALT flap, donor site management, preliminary results and complications are reported in this paper.

Section snippets

Materials and methods

Seven patients (six free ALT flaps) have been included in this study. Follow up ranges from 2 to 14 months (mean: 5 months). All patients were female to male transsexuals and their age at time of surgery ranged from 27 to 33. Five of them were heavy smokers (more than 20 cigarettes/day). Three of them presented a Pfannestiel suprapubic scar due to previous caesarean delivery (one case) and for previous hystero-oophorecomy (two cases). In one case the flap was not elevated because perforator

Results

In our series all the flaps (six cases) were harvested with a single perforator pedicle; in one case septocutaneous pedicle was found. The flap dimensions in different patients ranged from 10×12 to 11×14 cm2. In all six cases, the flap was raised without fascia. Only in two cases a partial defatting of the flap was performed. In one case the thigh lateral cutaneous nerve was not found.

In the seventh patient, the flap was not elevated because perforator vessels were not suitable; in this case,

Discussion

In the last 10 years, the ALT flap has become one of the most chosen options for soft tissue reconstruction because of its versatility, its adaptability to many different losses of substance in different regions and for the very low donor site morbidity. The free ALT flap can be used as an alternative to the free radial forearm flap in almost all clinical situations requiring soft tissue reconstruction. It is provided with a suitable vascular pedicle, it is sensate and can be elevated without

References (10)

There are more references available in the full text version of this article.

Cited by (141)

  • ALT phalloplasty: The Ghent technique

    2023, Atlas of Operative Techniques in Gender Affirmation Surgery
  • Gender Affirmation Surgery, Transmasculine

    2022, Urologic Clinics of North America
View all citing articles on Scopus
View full text