Forearm Flap in One-Stage Reconstruction of the Penis

Tc, Chang; Hwang, Wen-Yi

doi:10.1097/00006534-198408000-00014

Cited by 369 publications

(170 citation statements)

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“…19,20 The development of total phallic construction techniques has paralleled the evolution of flaps in plastic surgery and, after the initial attempt of Bogoras in 1936, who used a random pedicled oblique abdominal singular tubularized flap to create a phallus, a variety of techniques have been described in the literature. [20][21][22] However, only the advent of microsurgical techniques in plastic surgery has represented the real breakthrough in phallic reconstruction with the initial description of the radial artery-based forearm free flap (RAFF) phalloplasty by Chang and Hwang 23 and Song et al 24 This reconstructive procedure involved the creation of 'a tube within a tube' using forearm skin with the urethra fashioned from the nonhair-bearing area and the whole flap base on the radial artery. Contrariwise to all previous techniques, the RAFF allowed the creation of a cosmetically acceptable sensate phallus of cylindrical shape.…”

Section: Penile Shaft Reconstructionmentioning

confidence: 99%

An update on penile reconstruction

Garaffa¹,

Raheem²,

Ralph³

2011

Asian J Androl

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Section: Penile Shaft Reconstructionmentioning

confidence: 99%

An update on penile reconstruction

Garaffa¹,

Raheem²,

Ralph³

2011

Asian J Androl

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“…Bogoras [2] was the first to describe a phalloplasty operation in 1936, and although other techniques [3][4][5][6][7][8][9] have been described, none of them meet the ideal considerations, and complications are commonplace. In addition, there are few published series with > 20 patients [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Pedicled pubic phalloplasty in females with gender dysphoria

2004

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one stage in 32 patients and in two in 48; five patients did not wish to have the neourethra fashioned. RESULTSThe cosmetic appearance of the phallus was considered good in 68% of the patients. The major complications (in 60 patients) were related to the neourethra (75%) with stricture formation (64%) and/or fistulae (55%) predominating. This complication rate was significantly less ( P < 0.001) when the neourethra was created in two stages. Once the neourethra was completed, patients were then offered both penile and testicular prostheses. Sexual intercourse was possible with no prosthesis in 16 patients. CONCLUSIONSThe pubic phalloplasty offers an acceptable neophallus without disfiguring the donor skin site. The main complications stem from creating the neourethra and these may be reduced by a two-stage procedure.

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“…The microsurgically performed free forearm flap procedure, with cartilage insertion, has also been used. 1 It has probably yielded the best functional and aesthetic results, but it is not easy to perform, as it takes longer and has to be performed by two teams. Raising the scrotal flap to contain the spermatic cord and the attached testicle is a method that has been used for reconstructing a penis.…”

Section: Discussionmentioning

confidence: 99%

One-Stage Penile and Urethral Reconstruction - A New Extension of Inferiorly Based Rectus Abdominis Myocutaneous Flap

et al. 1990

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The loss of a penis, either through trauma or other causes, is psychologically and physiologically intolerable for the victim. The ideal reconstruction should be a reliable single-stage procedure that requires minimum hospitalization and yields acceptable cosmetic and functional results. The traditional techniques, which use tube flaps, are three-to five-stage procedures that are time consuming and physically and economically difficult for the patients. 1The rectus abdominis myocutaneous flap has gained popularity for various reconstructive procedures, including coverage of the groin, 2 thigh, 2 and above-knee amputation stumps. 3 Recently it has been used for vaginal and pelvic reconstruction. 4 We have used an interiorly based rectus abdominis myocutaneous flap to reconstruct an amputated penis and urethra as a single-stage procedure. Surgical ReportA six-year-old boy was referred to our unit for possible reconstruction for his knife-amputated penis, inflicted two years earlier by his psychologically disturbed mother. He was operated on twice at his local hospital, but no details of these attempted procedures were available.Examination revealed absence of the penis, with the urethral opening flush with the scrotum, which was normal (Figure 1). There were irregular scars over the upper medial aspects of both thighs and the groin, suggesting that a gracilis myocutaneous flap had been attempted previously. A micturating cystourethrogram showed a truncated urethra (3 cm), with a short stricture posteriorly.The patient was subsequently operated on using an inferiorly based rectus abdominis myocutaneous flap. At operation a suprapubic puncture cystostomy catheter was first introduced. The right rectus muscle was used as the source of the flap. A vertical skin strip (3 x 12 cm) extending from 3 cm below the xiphoid process to 3 cm below the umbilicus was marked and an incision made down to the anterior rectus sheath, which was incised vertically at the medial and lateral borders of the rectus (Figure 2). This area was then divided at the upper border of the flap and the superior epigastric artery ligated. The whole muscle was freed from the posterior rectus sheath and dissected downward, with the attached skin, care being taken not to injure the inferior epigastric artery.At the level of the inferior border of skin, fascia was separated from the muscle pedicle and the muscle further dissected down. Subcutaneous dissection in the suprapubic area was done and a tunnel was created, through which the flap was rotated and passed underneath to the recipient area (Figure 3). The skin was folded and sutured with interrupted 4-0 chromic catgut to reconstruct the urethra. The proximal end was anastomosed to the urethral opening after appropriate fashioning and a No. 10 Foley catheter was introduced down to the bladder as a stent.The distal end of the skin was folded back dorsally to shape the glans penis (Figure 3). The borders of the rectus were approximated ventrally over the attached skin urethral tube using 3-0 chromic. Th...

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Forearm Flap in One-Stage Reconstruction of the Penis

Cited by 369 publications

References 0 publications

An update on penile reconstruction

An update on penile reconstruction

Pedicled pubic phalloplasty in females with gender dysphoria

One-Stage Penile and Urethral Reconstruction - A New Extension of Inferiorly Based Rectus Abdominis Myocutaneous Flap

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