Pedicled superficial inferior epigastric artery perforator flap for salvage of failed metoidioplasty in female‐to‐male transsexuals

Schmidt, Manfred; Grohmann, Martin; Huemer, Martina

doi:10.1002/micr.22361

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…Other pedicle perforator flaps, based on superficial inferior epigastric artery (SIEA), deep inferior epigastric artery (DIEP), and superior gluteal artery (SGA), offer additional options for perineal reconstruction . However the SIEA and DIEP perforator flaps in our case were not applicable.…”

Section: Discussionmentioning

confidence: 79%

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

et al. 2016

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Fournier's gangrene is an acute and potentially lethal necrotizing fasciitis that can lead to extensive defects of the perineoscrotal area and lower abdominal wall as well. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Local perforator pedicle flaps and muscle flaps can be employed and combined for such a reconstruction. In this report we present a case of reconstruction of a massive perineoscrotal and upper medial thigh defect because of Fournier's gangrene using a bilateral pedicle anterolateral thigh (ALT) flap and sartorius muscle flap. A 61 year-old male who suffered from Fournier's gangrene resulted in a perineal, scrotal, and medial thigh defect of 27 × 30 cm with exposure of the femoral vessels. A bilateral pedicle ALT flap measuring 30 × 9 cm based on two perforators and a bilateral sartorius muscle flap were harvested for soft tissue defect reconstruction and inguinal vessels coverage, respectively. The flaps survived completely, with no recipient or donor site morbidity. The length of follow-up was 6 months and was uneventful. A bilateral pedicle ALT flap combined with bilateral sartorius flap may be considered as a valid and safe option for an extensive inguinal and perineoscrotal reconstruction in selected cases. © 2016 Wiley Periodicals, Inc. Microsurgery 37:669-673, 2017.

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Section: Discussionmentioning

confidence: 79%

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

et al. 2016

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“…All articles primarily pertained to metoidioplasty, with only 1 mentioning clitoral release, 12 even peripherally. Of the 11 identified articles, 3 were excluded for overlapping data with other included studies, 13e15 and 1 was excluded for being a revision surgery, 16 leaving a total of 7 primary articles for extraction. In all cases where there was overlapping data, the most recent article was used for abstraction.…”

Section: Resultsmentioning

confidence: 99%

Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes

Jolly

Boskey

et al. 2021

Sexual Medicine

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Introduction: There has been an exponential increase in referrals for transmasculine patients seeking genital affirmation surgery. Despite transgender men's equal interest in metoidioplasty and phalloplasty, research has primarily focused on phalloplasty. Aim: To summarize and investigate the relationship between surgical technique, complications, and patientsatisfaction. Methods: We performed a systematic review and meta-analysis of surgical techniques and physician-and patient-reported outcomes of gender-affirming clitoral release and metoidioplasty (PROSPERO# 158722) with literature from PubMed, Google Scholar, and ScienceDirect. Data were extracted using PRISMA guidelines. All searches, extractions, and grading were independently completed by 2 authors. Main Outcome Measures: Main measures were surgical technique, patient satisfaction, voiding, urethral stricture, and urethral fistula. Results and Conclusion: A total of 7 non-overlapping articles on metoidioplasty were identified, with a total of 403 patients. We identified 4 metoidioplasty techniques: Hage, Belgrade, labial ring flap, and extensive metoidioplasty. All techniques included urethral lengthening. The reported neophallus length ranged from 2 cm to 12 cm, with the smallest neophallus occurring with the labial ring flap technique and extensive metoidioplasty the largest. Across techniques, voiding while standing was reported in most patients, with the lowest rate reported with the labial ring flap (67%). Complications were impacted by surgical technique, with the lowest rates of fistula and stricture occurring with the Belgrade technique. Fistula rates ranged from 5% to 37%, while stricture ranged from 2% to 35% of patients. The Belgrade technique reported significantly lower rates of fistula and stricture (P ¼ .000). The patient-reported outcomes were described for the Belgrade technique and extensive metoidioplasty. Both techniques showed high aesthetic and sexual satisfaction. Transgender individuals can achieve an aesthetically and sexually satisfactory neophallus using a variety of metoidioplasty techniques; however, urethral outcomes vary significantly by technique. The Belgrade technique reported the best outcomes, although data remains limited. Patient priorities should be used to determine surgical technique. D Jolly, CA Wu, ER Boskey, et al. Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes. Sex Med 2020;XX:XXXeXXX.

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“…Other pedicle perforator flaps based on superficial inferior epigastric artery (SIEA) and superior gluteal artery (SGA) offer additional options for perineal reconstruction . However the SIEA perforator flap has poor donor site morbidity, and the SGA perforator flap cannot reach anterior defect such as the scrotum for coverage.…”

Section: Discussionmentioning

confidence: 99%

Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report

2015

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Fournier's gangrene can lead to extensive defects of the perineoscrotal area with exposure of the testes. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Due to its proximity, medial thigh skin appeared to be the most versatile donor site for perineoscrotal reconstruction. In this report, we present a case of reconstruction of a large perineoscrotal defect because of Fournier's gangrene using a posteromedial thigh (PMT) perforator propeller flap. A 58 year-old male who suffered from Fournier's gangrene resulted in a scrotal defect of 10 × 12 cm(2) with a large dead space. A pedicled PMT propeller flap measuring 9 × 23 cm(2) with two perforators that originated from the profunda femoris artery (PFA) was harvested for scrotal defect reconstruction and dead space obliteration. The flap survived completely, with no recipient or donor site morbidity. The length of followup was 3 months and was uneventful. The pedicled PMT propeller flap may be considered as a valid option for perineoscrotal reconstruction.

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Pedicled superficial inferior epigastric artery perforator flap for salvage of failed metoidioplasty in female‐to‐male transsexuals

Cited by 10 publications

References 16 publications

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes

Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report

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