Flap Combination Phalloplasty in Female-to-Male Transsexuals

Research output: Contribution to journalArticle

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;XX:XXX-XXX.

Original languageEnglish
JournalJournal of Sexual Medicine
DOIs
Publication statusPublished - Jan 1 2019

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Forearm
Calculi
Operative Time
Thigh
Venous Thrombosis
Fistula
Sex Reassignment Surgery
Tissue Donors
Epigastric Arteries
Perforator Flap
Morbidity
Lymphedema
Hypesthesia
Operative Surgical Procedures
Cicatrix
Necrosis
Hand
Demography

Keywords

  • Female-to-Male Transsexual
  • Flap Combination Phalloplasty
  • Sex Reassignment Surgery
  • Single Flap Phalloplasty

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology
  • Urology

Cite this

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title = "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;XX:XXX-XXX.",
keywords = "Female-to-Male Transsexual, Flap Combination Phalloplasty, Sex Reassignment Surgery, Single Flap Phalloplasty",
author = "Yuzaburo Namba and Toshiyuki Watanabe and Yoshihiro Kimata",
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doi = "10.1016/j.jsxm.2019.02.010",
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N2 - 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;XX:XXX-XXX.

AB - 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;XX:XXX-XXX.

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