Partial flap loss in transgender phalloplasty using the anterolateral thigh or forearm - a systematic literature review

doi:10.20517/2347-9264.2020.85

Plast Aesthet Res

2020

DOI: 10.20517/2347-9264.2020.85

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Partial flap loss in transgender phalloplasty using the anterolateral thigh or forearm - a systematic literature review

Abstract: Aim: In this study, we systematically review the current literature regarding partial flap loss (PFL) for the two most commonly performed types of phalloplasty, the radial forearm and the anterolateral thigh flaps. The primary purpose is to synthesize the available information to clarify anatomic location, etiology, extent of flap loss, and management thereof. Second, we utilize this information to inform strategies to mitigate the risk of PFL. Methods: A systematic review of all abstracts published on phallop… Show more

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“…3,4 Aside from reporting incidence rates, existing literature on PFL lacks details on the clinical significance, anatomic location, extent, and management as summarized by a recent systematic review by our group. 5 Therefore, there exists a need for further research regarding PFL in gender affirming phalloplasty. In this article, we review a single surgeon's experience with PFL when performing phalloplasty as part of gender affirming surgery.…”

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Partial Flap Loss in Gender Affirming Phalloplasty

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Heston

Carboy

et al. 2021

J Reconstr Microsurg

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Background Flaps used in phalloplasty are larger than described for other indications, with a design that is tubularized up to two times. While the incidence of partial flap loss (PFL) is well described, current literature lacks granularity comparing donor sites and techniques with minimal discussion of etiology and management. The purpose of this study was to review our experience with PFL in phalloplasty. Methods This was a retrospective cohort study of patients who underwent phalloplasty by a single surgeon at a single institution between 2016 and 2020. PFL was defined as any patient requiring sharp excision of necrotic tissue and reconstruction. Patient variables (demographics, body mass index, American Society of Anesthesiologists physical status classification, comorbidities), flap variables (donor site, design, dimensions, perforator number) and intraoperative variables (use of vasopressors, intraoperative fluid volume) were collected. Results Of 76 phalloplasties, 6 patients suffered PFL (7.9%). 5/6 patients were radial forearm free flap tube-within-tube (TWT) and 1/5 patients were pedicled anterolateral thigh TWT. 4/6 cases involved the shaft only and were treated with excision ± Integra and full-thickness skin grafting. 2 cases of PFL involved the urethral extension requiring excision of the necrotic segment. Conclusion PFL occurred in 7.9% of cases and was solely found in the TWT cohort. The majority of cases involved the shaft, sparing the urethral segment. Cases in the acute postoperative period appeared to be related to macrovascular venous congestion, while cases in the subacute period appeared to be due to microvascular arterial ischemia.

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Partial Flap Loss in Gender Affirming Phalloplasty

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Heston

Carboy

et al. 2021

J Reconstr Microsurg

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Outcomes Following Gender Affirming Phalloplasty: A Systematic Review and Meta-Analysis

Wang

Tsang

Mankowski

et al. 2022

Sexual Medicine Reviews

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Introduction Phalloplasty is one of the genital genders affirming surgeries sought by transmasculine transgender patients during transition. Despite current advances in surgical techniques, the lack of consistency in outcomes evaluation for phalloplasty leads to significant challenges in guiding patients in clinical decision making. Aims This systematic review and meta-analysis aims to assess outcomes for different phalloplasty surgical techniques. Methods The literature was searched using Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica database, and Cochrane Database of Systematic Reviews. All English-language randomized control trials, prospective and retrospective cohort studies, case series, and case reports of at least 4 patients were included. The primary outcome was postoperative complications, and the secondary outcomes were functional and aesthetic results. Proportional meta-analysis was used to pool complication rates using a random-effects model. Results Database searching generated 39 final articles, with 19 case series, 3 cross-sectional studies, and 17 retrospective cohort studies. A total of 1731 patients underwent phalloplasty, with the most common type of reconstruction performed being the radial forearm free flap (75.1%). Overall complication rate was high at 76.5%, of which urethral complications were high in all reconstructive subgroups (urethral fistula rate of 34.1% and urethral stricture rate of 25.4%). Postoperative functional outcomes were reported in 57.6% of patients, finding that most had tactile sensation (93.9%) and can void while standing (92.2%). Aesthetic outcomes were only reported in 6.3% of patients, with mean length achieved being 12.26 cm (SD = 0.81 cm) and mean circumference being 10.18 cm (SD = 3.69 cm). Conclusion In the transmasculine transgender population, current evidence of the various phalloplasty surgical techniques and their expected postoperative outcomes is weak. Future research may consider developing a standardized core outcome set to improve clinical decision making.

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Partial flap loss in transgender phalloplasty using the anterolateral thigh or forearm - a systematic literature review

Cited by 2 publications

References 29 publications

Partial Flap Loss in Gender Affirming Phalloplasty

Partial Flap Loss in Gender Affirming Phalloplasty

Outcomes Following Gender Affirming Phalloplasty: A Systematic Review and Meta-Analysis

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