Microsurgical Forearm “Cricket Bat—Transformer” Phalloplasty

Gilbert, David A.; Jordan, Gerald H.; Devine, Charles J.; Winslow, Boyd H.

doi:10.1097/00006534-199210000-00027

Cited by 35 publications

(10 citation statements)

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“…The initial tube-in-a-tube design by Chang and Hwang 3 has undergone numerous modifications. 7,8,[12][13][14][15][16][17][18][19][20] These include methods to improve the blood supply 12 or eliminate the circumferential meatal suture line (e.g., by centrally locating the neourethra 13 ). However, the maximum available width of the radial forearm flap is 15 cm 21 in most instances and is possibly even smaller in the Oriental population.…”

Section: Discussionmentioning

confidence: 99%

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Modifications of the Radial Forearm Flap Phalloplasty for Female-to-Male Gender Reassignment

Song

Wong

et al. 2010

J reconstr Microsurg

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The radial forearm flap remains the preferred technique for phalloplasty. From 1999 to 2009, 19 patients with primary female transsexualism underwent gender reassignment surgery at our center. The radial forearm flap phalloplasty is modified as a two-stage procedure, with prelamination of the neourethra on the donor forearm before microsurgical transfer 3 months later. At 5-year follow-up, patients were asked to complete a survey on the functional, aesthetic, and psychological results postsurgery. The radial forearm flap reliably provided sufficient bulk with stiffness for the neophallus with acceptable aesthetic appearance. We further describe technical modifications to reduce the rate of urethral strictures and fistulas. None of the patients regretted undergoing gender transformation. Patients are satisfied with the surgical result and generally prepared to accept its potential costs, in view of the significant psychological and legal benefits.

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Section: Discussionmentioning

confidence: 99%

“…21 The initial urologic complication rate was quoted as 41% in a recent study. 19 Semple et al proposed the ''cricket bat'' design, 15,16 in which the neourethra was extended distally over the radial artery, shaped into a tube, and then rotated proximally. This design reduced the donor width with a decrease in meatal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Modifications of the Radial Forearm Flap Phalloplasty for Female-to-Male Gender Reassignment

Song

Wong

et al. 2010

J reconstr Microsurg

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“…The neophallus is generally formed from tissue taken from the inner forearm skin (on the patient’s nondominant side) as well as vaginal tissue to form the neourethra. The use of the radial forearm free flap is well described by a great number of different authors in genital reconstructive surgery ( 22 , 23 , 25 ). This flap is supplied by the radial artery and by the paired vena comitantes.…”

Section: Phalloplastymentioning

confidence: 99%

Novel surgical techniques in female to male gender confirming surgery

Djordjević¹

2018

Transl. Androl. Urol.

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The current management of female to male (FTM) gender confirmation surgery is based on the advances in neo phalloplasty, perioperative care and the knowledge of the female genital anatomy, as well as the changes that occur to this anatomy with preoperative hormonal changes in transgender population. Reconstruction of the neophallus is one of the most difficult elements in surgical treatment of female transsexuals. While there is a variety of available surgical techniques, their results are not equally acceptable to all patients. The preference for a particular surgical technique mostly depends on the patient’s desires and expectations. Nevertheless, the surgeon’s duty is to fully inform the patient about all the advantages and disadvantages, as well as all complications that might occur after surgical procedure—and even to talk them out of a desired surgical technique if there are contraindications. Metoidioplasty is a technically demanding surgical procedure used in FTM transsexuals who desire a gender reassignment surgery (GRS) without undergoing a complex, multi-staged surgical creation of an adult-sized phallus. Metoidioplasty is viable in cases where the clitoris seems large enough after androgen hormonal treatment. Since the clitoris plays the main role in female sexual satisfaction, its impact on the outcome of FTM transgender surgery is predictable. Various free flaps have been reported for total phalloplasty, such as radial forearm flap, latissimus dorsi flap, anterolateral tight flap, different abdominal wall flaps, free deltoid flap, scapular free flap, sensate osteocutaneous free fibula flap, tensor fasciae latae, deep epigastric artery perforator flap and dorsalis pedis flap. The fact that there are so many techniques for penile reconstruction in cases of penis absence, proves that none of the above mentioned techniques succeeded in achieving the ideal goals of penis reconstruction. We will emphasize the most commonly used surgical techniques in genital confirmation in FTM transsexuals with reference to respective eligibility criteria for each procedure.

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“…After the success of this series, many teams adopted this technique and applied some modifications in flap design, to improve the cosmesis of the neophallus and to minimize the overall complication rate and donor site morbidity that can occur in 45% of cases [18]. In particular, the shape of the forearm flap has been modified to improve the blood supply to the flap and to reduce the risk of meatal stenosis [19–24]. Ulnar artery‐based flaps to reduce the amount of hair‐bearing skin incorporated have also been used [25].…”

Section: Introductionmentioning

confidence: 99%

Total phallic reconstruction after penile amputation for carcinoma

et al. 2009

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OBJECTIVE To report our experience of total phallic reconstruction (TPR) with the use of the radial‐artery free flap (RAFF) in patients who have had a subtotal penectomy for penile or urethral cancer, as the goal of TPR is the creation of a sensate and cosmetically acceptable phallus with an incorporated neourethra that allows the patient to void while standing, and with the insertion of a penile implant to resume sexual activities, improving quality of life. PATIENTS AND METHODS The notes of the 15 patients who had undergone RAFF TPR between January 1998 and May 2008 were reviewed retrospectively. The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery and patient satisfaction were recorded during the follow‐up. RESULTS This technique allowed the reconstruction of a cosmetically acceptable phallus in all patients. After a median (range) follow‐up of 20 (1–68) months all patients were satisfied with the cosmesis and size of the phallus, and 14 were able to void while standing. Among the seven patients who have subsequently had insertion of a penile prosthesis, five can now engage in sexual intercourse. Urethral strictures and fistulae were the commonest complications in, respectively, three and four cases, and one patient had his penile prosthesis explanted because of infection. CONCLUSIONS RAFF phalloplasty is an excellent technique for TPR, giving excellent cosmetic and functional results.

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Microsurgical Forearm “Cricket Bat—Transformer” Phalloplasty

Cited by 35 publications

References 0 publications

Modifications of the Radial Forearm Flap Phalloplasty for Female-to-Male Gender Reassignment

Modifications of the Radial Forearm Flap Phalloplasty for Female-to-Male Gender Reassignment

Novel surgical techniques in female to male gender confirming surgery

Total phallic reconstruction after penile amputation for carcinoma

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