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. 2008:2008:704343.
doi: 10.1155/2008/704343. Epub 2008 Nov 4.

Reconstructive surgery for severe penile inadequacy: phalloplasty with a free radial forearm flap or a pedicled anterolateral thigh flap

N Lumen  1 , S Monstrey, P Ceulemans, E van Laecke, P Hoebeke
Affiliations

Reconstructive surgery for severe penile inadequacy: phalloplasty with a free radial forearm flap or a pedicled anterolateral thigh flap

N Lumen et al. Adv Urol. 2008.

Abstract

Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy. Methods. Eleven males (age 15 to 42 years) were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4-49 months). Aesthetic and functional results were evaluated. Results. There were no complications related to the flap. Aesthetic results were judged as "good" in 9 patients and "moderate" in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula). Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion. Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.

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Figures

Figure 1
Figure 1
Incorporation of residual penile tissue at the base of the phallus.
Figure 2
Figure 2
The radial forearm free flap using the tube-in-a-tube principle for creation of the neourethra.
Figure 3
Figure 3
The anterolateral thigh flap. (a) Preoperative: the vascular pedicle is marked at the middle using Doppler-ultrasound. (b) Postoperative.
Figure 4
Figure 4
Excellent aesthetic appearence after RFF (a)-(b) and ALTF (c) phalloplasty.
See this image and copyright information in PMC

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