A New Technique for Coronaplasty in Penile Reconstruction

Abstract

Background The coronaplasty is an important step of the phalloplasty procedure as it creates a prominent coronal ridge and a constricted coronal sulcus, resulting in the transformation of a regular skin flap into a flap resembling a circumcised penis. Aim The aim of this article is to describe our new coronaplasty technique that exploits opposing contracting forces of 2 different skin grafts to hold the shape of a thick, distally based skin flap, resulting in a natural looking neo-phallus. Methods A distally based flap is raised at the junction of the middle and distal thirds of the neo-phallus. The dissection continues until adequate mobilization is obtained, so the flap can stand almost perpendicular to the axis of the shaft. 2 separate full-thickness skin grafts are harvested and placed: the first at the raw undersurface of the flap, the second at the flap's donor site. To make the sulcus deeper and to define the ridge, the lower part of the graft placed on the undersurface of the distal flap is sutured with tacking sutures. Depending on the type of flap used this procedure can be done during the phalloplasty procedure itself (axial flaps) or at least 1 week later (perforator flaps). Outcomes The new technique that we developed shows a more distinct coronal sulcus and coronal ridge, long-lasting results, and a more aesthetically pleasing and natural-appearing glans penis. Results The harvested distal flap is progressively thicker and not folded, resulting in a more naturally looking ridge. The donor site is deeper than other techniques, creating a well-defined sulcus. By using 2 skin grafts the opposing force vectors increase the projection of the ridge and the deepness of the sulcus. Clinical Translation This technique results in a more prominent glans penis and is an important step in creating an almost naturally looking neo-phallus. Conclusions This procedure can be applied to all different kind of flaps used for phalloplasty, both in an immediate or delayed fashion. As grafts are used, partial or complete graft lost can appear. Furthermore, attention must be paid not to incise the distal flap too deep so vascularity to the distal part of the flap will not be impaired. A continuous search to optimize the aesthetic outcome of the phalloplasty procedure is necessary and with this new coronaplasty technique we hope to raise attention and take another step toward creating “the real thing.”

30 Years of Experience in Musculocutaneous Latissimus Dorsi Flap Phalloplasty with Reinnervation: Optimal Principles

“…In the mandatory primary imitation of the external urethra and the coronary sulcus, 27 the simple steps do not lengthen the operative time (performed in parallel with the closure of the donor back defect) and provide the neophallus a natural shape and appearance, which is extremely beneficial for the patient’s psychological well-being (especially important for transgender patients) and directly affects the quality of their social rehabilitation. 28 Our experience has demonstrated that an aesthetic and authentic appearance of the neophallic external urethra imitation in 20% of cases may lead to abandonment of the second urethroplasty step.…”

High Surgical Complication Rates after Silicone Implant Use for Improvement of Glans Ridge Appearance

“…The Norfolk technique, which builds on Munwar’s original method but integrates a skin graft, is currently most popular, due to its ability to create a circumcised appearance of the glans with low complications. Other procedures, such as the Gottleib design 7 (to improve pigmentation) and various alternative methods of coronaplasty, 2 , 4 , 8 have been described to optimize the results of the classic Norfolk technique. Still, none yet seem to be provably superior to the base concept of Norfolk: a distal skin ridge folded over with a more proximal skin graft, and a skin graft proximal to this to cover the defect left by the glans creation.…”

“…An incision is made at the appropriate point at the distal phallus and the distal phallus skin flap developed as the gland ridge, as described in most glansplasty techniques. [1][2][3][4] A 100% medical-grade silicone carving block is used to create a hand-carved glans ridge implant of the correct length, tapered at both ends. It is generally 5 × 5 mm in maximum thickness and triangular in cross section (Fig.…”

„Wahl der Lappenplastik zur Phalloplastik – was ist zeitgemäßer Standard“ – Konsensus-Bericht der deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße

“…Diese kann auf Wunsch der Patienten unabhängig von der Art der durchgeführten Phalloplastik durch die Konstruktion eines Sulcus coronarius gebildet werden (▶Abb. 4) [49,81]. Die Sulcuscoronarius-Plastik kann bei axial gestielten Lappenplastiken wie der Radialislappenplastik simultan zur Phalloplastik erfolgen.…”