Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals

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Summary

Gender reassignment operations in female-to-male transsexuals are increasing in number as the skill of phalloplasty develops. The authors are performing phalloplasty 1 year after undergoing mastectomy, reduction of nipples, oophrectomy and hysterectomy in female-to-male transsexuals.

The ideal penile reconstruction should be a single-stage procedure, creating a phallus with both tactile and erogenous sensibility, water-tight neourethra allowing for voiding in the standing position, enough bulk with stiffness, and an aesthetically acceptable appearance.

We performed phalloplasty with radial forearm osteocutaneous free flaps on 40 female-to-male transsexual patients from March 1991 to December 2005. We investigated the results with regard to aesthetic and functional status and complications through physical examinations and interviews over a period of 14 years.

The results are as follows:

  • 1.

    Fistula on the neourethra is the most frequent and troublesome complication.

  • 2.

    The autogenous bone or cartilage seems to be a reliable stiffener in the construction of the phallus.

  • 3.

    Erogenous sensibility of the constructed phallus was relatively good.

  • 4.

    The benefits of phalloplasty with radial forearm free flaps include the fact that it is a single stage procedure, acceptable aesthetic appearance, enough bulk and length, good sensation and the feasibility of inserting a stiffener in the penile shaft.

In conclusion, we have been able to construct a good phallus with radial forearm osteocutaneous free flaps that is aesthetically and functionally acceptable. In addition, complications have been minimal.

Section snippets

Patients

We performed 40 cases of phalloplasty in female-to-male transsexuals with radial forearm osteocutaneous free flap at Dong-A University Hospital between March 1991 and December 2005. The mean age at the time of operation was 34, ranging from 15 to 53. All female-to-male transsexuals had already undergone mastectomy, oophorectomy and hysterectomy. For these patients, the follow-up period was 1 to 14 years after the operation, with the average follow-up period being 72 months.

Design of the radial forearm osteocutaneous free flap

The design involved

Results

All of our patients were extremely grateful for their surgery.

Almost all patients were satisfied with the appearance of the constructed phallus; 35 patients thought the result was excellent and four patients thought it good (Figure 4, Figure 5). The constructed phallus with osteocutaneous flap had sufficient firmness to perform satisfactory sexual intercourse. But about 1 year after the operation, some constructed phalluses had a soft shaft due to the absorption of adipose tissue; we then

Discussion

Numerous attempts to reconstruct the male phallus have been made since Bogoraz3 performed the first total penis reconstruction with tubed abdominal flap in 1936, and it has remained a very fascinating field and still a great challenge for plastic surgeons. To date, some problems still exist in making the reconstructed phallus a satisfactorily functioning organ. It remains an extremely difficult proposition to obtain a watertight urethra in transsexuals. The anatomy and function of the male

References (13)

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    In contrast, vibration sensation was poor in this collective. Kim et al17 analyzed 44 phalli constructed with a radial forearm osteocutaneous flap. They also adapted the Chang technique and used the ulnar side of the flap for tubing the urethra.

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