Fibula free flap phalloplasty: Modifications and recommendations

Hage, J. Joris; Winters, H.A.H.; Lieshout, Jesse Van

doi:10.1002/(sici)1098-2752(1996)17:7<358::aid-micr3>3.0.co;2-c

Cited by 50 publications

(30 citation statements)

References 23 publications

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“…For this, a radial forearm free flap (n ϭ 9), 2 an upper arm free flap (n ϭ 1), 12 an osteocutaneous fibula free flap (n ϭ 1), 13 or an extended iliac pedicled flap (n ϭ 1) has been used. 14 As 5 additional patients were scheduled for additional phalloplasty, a total of 17 out of our 70 patients (0.24) requested more comprehensive phalloplasty after having undergone metaidoioplasty.…”

Section: Postmetaidoioplasty Phalloplastymentioning

confidence: 99%

Long-Term Outcome of Metaidoioplasty in 70 Female-to-Male Transsexuals

Hage

Turnhout

2006

Annals of Plastic Surgery

102

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In 1996, metaidoioplasty was introduced as an alternative to phalloplasty in female-to-male transsexuals. To assess the long-term outcome in 70 consecutive patients (mean follow-up 8 years), we established the characteristics of postoperative events and additional surgical procedures. Metaidoioplasty and primary or secondary scrotoplasty was uneventful in 8 patients. In the other patients, postoperative events included immediate postoperative complications (n = 23), urethral fistulas (n = 26) or strictures (n = 25), or loss (n = 22) or dislocation (n = 34) of testicular prostheses. An average of 2.6 surgical procedures per patient was needed to complete genital confirmation and cope with all events. Additional phalloplasty was performed or scheduled in 17 patients. We conclude that genital reassignment by metaidoioplasty cannot usually be completed in 1 step and that phalloplasty is feasible subsequent to metaidoioplasty. We still consider metaidoioplasty to be a method of choice in selected patients.

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Section: Postmetaidoioplasty Phalloplastymentioning

confidence: 99%

Long-Term Outcome of Metaidoioplasty in 70 Female-to-Male Transsexuals

Hage

Turnhout

2006

Annals of Plastic Surgery

102

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“…5) (Papadopulos et al, 2008). The proximal end of the fibula is fixed to the periosteum of the pubic symphysis using sutures and tiny burr holes (Sadove et al, 1993;Papadopulos et al, 2008;Hage et al, 1996).…”

Section: The Surgical Techniquementioning

confidence: 99%

The anatomy of free fibula osteoseptocutaneous flap in neophalloplasty in transgender surgery

et al. 2018

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The Free Fibula Osteoseptocutaneous flap is a reliable option when used in neophalloplastic procedures. It possesses intrinsic rigidity that is sufficient for penetrative intercourse, and satisfactory sensation. We review the pros and cons of this procedure, as well the anatomy and surgical steps involved. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. Anatomy of the donor and recipient sites, as well as the surgical technique leading to creation of the neophallus are demonstrated in detail with new relevant illustrations. The free fibula osteoseptocutaneous flap provides the neophallus with many desirable characteristics. Its thick subcutaneous and fascial layer, along with the thicker fibula (compared to the radius), allows for a neophallus of greater diameter. Skin marking, flap lifting, and transfer to the perineum with all relevant neurovascular anastomosis; fibular artery is anastomosed with the femoral artery, while the fibular veins are anastomosed to branches of the saphenous vein, as well as neurorrhaphy of the dorsal nerves of the clitoris and the LSCN are demonstrated. The osteomatized fibula is fixed to the periosteum of the pubic symphysis as shown. Anatomical traits of the Free Fibula Osteoseptocutaneous flap allow intercourse without prosthesis. The donor-site scar in this procedure can be covered by a long sock, and donor site morbidity is acceptable. Clin. Anat. 31:169-174, 2018. © 2018 Wiley Periodicals, Inc.

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“…11). 19,20 Sadove et al found that prelamination of the neo-urethra reduced the incidence of urethral fistulas 21 and better controlled girth because the flap is wrapped around the urethra rather than tubed. For prelamination of the neo-urethra a full thickness skin graft wrapped around a catheter is inserted into the leg.…”

Section: Myocutaneous Latissimus Dorsi Flapmentioning

confidence: 99%

“…Hage et al recommend preoperative sensory marking by injecting lidocaine over the biceps femoris tendon and marking the resulting numb area on the lateral aspect of the lower leg. 20 The bone is then fixed to the penile corpora cavernosa or the pubic symphysis. Hage et al suggest making the bone $2 cm longer than the skin paddle so that the phallus is not floppy.…”

Section: Myocutaneous Latissimus Dorsi Flapmentioning

confidence: 99%

Phalloplasty in Complete Aphallia and Ambiguous Genitalia

Bluebond-Langner

Redett

2011

Seminars in Plastic Surgery

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The most common indications for phalloplasty in children include aphallia, micropenis/severe penile inadequacy, ambiguous genitalia, phallic inadequacy associated with epispadias/bladder exstrophy and female to male gender reassignment in adolescents. There are many surgical options for phalloplasty; both local pedicled tissue as well as free tissue transfer. The advantages of local tissue include a more concealed donor site, less complex operation and potentially faster recovery. However, pedicled options are generally less sensate, making placement of a penile prosthesis more risky and many children with bladder exstrophy have been previously operated upon making the blood supply for local pedicled flaps less reliable. This Here the authors discuss free tissue transfer, including the radial forearm, the anterolateral thigh, the scapula and latissimus, and the fibula free flaps, as well as local rotational flaps from the abdomen, groin, and thigh. The goal of reconstruction should be an aesthetic and functional (ability to penetrate) phallus, which provides tactile and erogenous sensation, and the ability to urinate standing. Ideally, the operation should be completed in one to two operations with minimal donor site morbidity. There are advantages and disadvantages of each of flap and thus the choice of donor site should be a combination of the patient's preference and surgeon's ability to produce a consistent result.

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Fibula free flap phalloplasty: Modifications and recommendations

Cited by 50 publications

References 23 publications

Long-Term Outcome of Metaidoioplasty in 70 Female-to-Male Transsexuals

Long-Term Outcome of Metaidoioplasty in 70 Female-to-Male Transsexuals

The anatomy of free fibula osteoseptocutaneous flap in neophalloplasty in transgender surgery

Phalloplasty in Complete Aphallia and Ambiguous Genitalia

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