Total phallic reconstruction in female-to-male transsexuals

Abstract

Background: The goal of total phallic construction is the creation of a sensate and cosmetically acceptable phallus. An incorporated neourethra allows the patient to void while standing, and the insertion of a penile implant allows the patient to resume sexual activities, thus improving quality of life.

Objective: To report our experience of total phallic construction with the use of the radial artery free flap in female-to-male transsexuals.

Design, settings, and participants: The notes of the 115 patients who underwent total phallic construction with the use of the radial artery-based forearm free flap between January 1998 and December 2008 were reviewed retrospectively.

Measurements: The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery, and patient satisfaction were recorded during the follow-up.

Results and limitations: This technique allowed the reconstruction of a cosmetically acceptable phallus in 112 patients; 3 patients lost the phallus due to venous thrombosis in the immediate postoperative period. After a median follow-up of 26 mo (range: 1-270 mo), 97% of patients are fully satisfied with cosmesis and size of the phallus. Sensation of the phallus was reported by 86% of patients. Urethral strictures and fistulae in the phallus and join-up site were the most common complications, occurring respectively in 9 and 20 patients; however, after revision surgery, 99% of patients were able to void from the tip of the phallus while standing.

Conclusions: The radial artery-based forearm free flap technique is excellent for total phallic construction, providing excellent cosmetic and functional results.