Flap Combination Phalloplasty in Female-to-Male Transsexuals.
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;16:934-941.
['Namba|Yuzaburo|Y|', 'Watanabe|Toshiyuki|T|', 'Kimata|Yoshihiro|Y|']
D000328:Adult D002921:Cicatrix D005260:Female D006801:Humans D008297:Male D010413:Penis D011183:Postoperative Complications D012189:Retrospective Studies D057830:Sex Reassignment Surgery D013524:Surgical Flaps D013848:Thigh D014189:Transsexualism D014522:Urethral Diseases D014548:Urinary Fistula
Flap Combination Phalloplasty Female-to-Male Transsexual Sex Reassignment Surgery Single Flap Phalloplasty