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

Song, Colin; Wong, Manzhi; Wong, Chin‐Ho; Ong, Yee-Siang

doi:10.1055/s-0030-1268210

Cited by 55 publications

(66 citation statements)

References 22 publications

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“…Satisfaction of the scar of the RFF in transsexual men cannot be compared to RFF used for oncologic indications in head and neck surgery . This acceptable rating of the scar is consistent with previous results of our group and of other series . However, when asked about particular aspects of the scar, patients do score their scars worse than the dermatologist.…”

Section: Discussionsupporting

confidence: 85%

Long-Term Evaluation of Donor-Site Morbidity After Radial Forearm Flap Phalloplasty for Transsexual Men

Caenegem

Verhaeghe

Taes

et al. 2013

The Journal of Sexual Medicine

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Introduction Phalloplasty using the radial forearm flap is currently the most frequently used technique to create the neophallus in transsexual men (formerly described as female-to-male transsexual persons). Although it is considered the gold standard, its main disadvantage is the eventual donor-site morbidity in a young, healthy patient population. Aim The study aims to examine the long-term effects of radial forearm flap phalloplasty in transsexual men and to evaluate aesthetic outcome, scar acceptance, bone health, and daily functioning. Main Outcome Measures Scars were evaluated with the patient and observer scar assessment scale, the Vancouver Scar Scale, and self-reported satisfaction. Bone health was assessed using dual X-ray absorptiometry and peripheral quantitative computed tomography, and daily functioning using a physical activity questionnaire (Baecke). These measurements were compared with 44 age-matched control women. Methods This is a cross-sectional study of 44 transsexual, a median of 7 years after radial forearm flap phalloplasty, recruited from the Center for Sexology and Gender Problems at the Ghent University Hospital, Belgium. Results We observed no functional limitations on daily life activities, a pain-free and rather aesthetic scar, and unaffected bone health a median of 7 years after radial foreram flap phalloplasty. Over 75% of transsexual men were either satisfied or neutral with the appearance of the scar. Conclusions Transsexual men, despite scarring the forearm, consider the radial forearm flap phalloplasty as worthwhile.

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Section: Discussionsupporting

confidence: 85%

Long-Term Evaluation of Donor-Site Morbidity After Radial Forearm Flap Phalloplasty for Transsexual Men

Caenegem

Verhaeghe

Taes

et al. 2013

The Journal of Sexual Medicine

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“…A two stage phalloplasty with urethral prelamination using a full thickness graft has been used with all the commonly used free flaps including the RFFF,[5354] osteocutaneous radial forearm flap,[36] OCFF,[44] ALTF. [55] Prelaminated OCFF phalloplasty has fistula rates ranging from 15 to 22,[4445] and up to 32% urethral stricture rates.…”

Section: Urethroplastymentioning

confidence: 99%

Phalloplasty: The dream and the reality

Rashid

Tamimy

2013

Indian J Plast Surg

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Phalloplasty has come a long way as Plastic Surgery has evolved over the years. The complication ridden multistage tube pedicles popularized by Gillis were, with the advent of microsurgery, replaced by radial forearm flaps. The composite osteo-cutaneous version of this flap promised ‘All for one and one for all’ assuring both a reliable urinary conduit and a phallus stiffener. Prelamination and prefabrication to make the neo-urethra came with the promise of reducing both fistula and strictures but that did not happen and flap failure rates increased. Penile stiffeners of various types have been introduced; the artificial ones were associated with high infection and failure rates and are best inserted after the neo-penis regains some sensitivity. With the introduction of perforator flaps the Anterolateral thigh flap in its sensate pedicled form has started replacing the Radial forearm free flap as the first choice flap because of a hidden donor area and lack of microsurgical expertise requirement. Being sensate it tolerates a stiffener better. It is now possible to reconstruct an aesthetically pleasing glans as well, thus meeting both the aesthetic and functional desires of the patient. Complications encountered in this reconstructive effort include flap failure, urethral fistula, urethral stricture and stiffener related problems.

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“…Non-genital operations include breast augmentation, vocal cord and throat surgery, and facial feminization [7]. Female-to-male (FTM) gender reassignment includes genital operations such as scrotal reconstruction (scrotoplasty including testicular implants), penile reconstruction (metoidioplasty or phalloplasty), hysterectomy, oophorectomy, and vaginectomy, and non-genital operations such as mastectomy [7,8]. Many of the operative procedures for gender reassignment (e.g., hysterectomy, oophorectomy, and vaginectomy) are now accomplished laproscopically [7].…”

mentioning

confidence: 99%

“…Potential complications of MTF operations are bleeding resulting in labial hematoma, formation of a rectal fistula to the neovagina, and meatal stenosis [7]. Complications of FTM operations include forearm cellulitis, tip necrosis following free-flap phalloplasty, flap loss, neoscrotal abscess, urethral fistula, and urethral stricture [8].…”

mentioning

confidence: 99%

Surgical Site Infections in Genital Reconstruction Surgery for Gender Reassignment, Detroit: 1984–2008

Zhao

Marchaim

Palla

et al. 2014

Surgical Infections

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Background: Gender reassignment surgery (i.e., male-to-female or female-to-male) entails a series of complex surgical procedures. We conducted a study to explore epidemiologic characteristics of patients who underwent genital reconstruction operations as components of gender reassignment and to analyze risk factors for surgicalsite infections (SSIs) following these operations. Methods: The study was a retrospective cohort study conducted from 1984-2008 at Harper University Hospital, a tertiary hospital with 625 beds in Detroit, Michigan. Surgical site infection was defined according to established criteria. Results: Records were available for 82 patients who underwent a total of 1,383 operations as part of genitalreconstruction processes. Thirty-nine (47.6%) of the patients underwent female-to-male reassignment (FTM) and 43 (52.4%) underwent male-to-female reassignment (MTF). The average age of the study cohort was 39.5 -9.8 y.Of the patients in the cohort, 56 (68.3%) were Caucasian and 67 (81.7%) were single. The average number of operative encounters per patient was 11.8 -4.6 for FTM and 4.9 -2.4 for MTF. Forty-three (52.4%) patients developed an SSI at least once during their genital reconstruction process, of whom 34 (87%) were in the FTM group and nine (21%) in the MTF group (p < 0.001). Staphylococci were the most common pathogens (61%) isolated in these infections, followed by Enterobacteriaceae (50%), Enterococcus (39%), and Pseudomonas aeruginosa (33.3%). Surgical site infection was associated independently with an increased frequency of operative procedures and operating room encounters. Conclusions: More than 50% of patients who underwent genital reconstruction operations developed an SSI at some point during the genital reconstruction process. Surgical site infections are more common in FTM than in MTF reconstruction operations, and for both FTM and MTF, SSIs are associated independently with an increased frequency of total operative procedures and encounters.

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

Cited by 55 publications

References 22 publications

Long-Term Evaluation of Donor-Site Morbidity After Radial Forearm Flap Phalloplasty for Transsexual Men

Long-Term Evaluation of Donor-Site Morbidity After Radial Forearm Flap Phalloplasty for Transsexual Men

Phalloplasty: The dream and the reality

Surgical Site Infections in Genital Reconstruction Surgery for Gender Reassignment, Detroit: 1984–2008

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