Phalloplasty in biological men with penile insufficiency

Penile reconstruction: An up-to-date review of the literature

“…Regardless of methods, both RFFF and ALTF result in good erogenous sensation. The main drawback lies in the urinary complications, particularly strictures and fistulae, that often necessitate a second corrective surgery [ 31 ]. Therefore, ensuring the patient is fully informed of the potential complications and, should one arise, high likelihood of an additional surgery is of utmost importance.…”

“…The most commonly used donor sites are the forearm and anterolateral thigh [ 26 ]. As we will discuss, the RFFF is the gold standard, and is the most commonly performed type [ 31 ]. RFFF achieves high patient satisfaction with cosmetic appearance and phallic urination [ 26 ].…”

“…However, RFFF does leave a large scar on the forearm that patients may find unappealing [ 26 ]. The ALTF is a good option for patients that prefer to hide the donor scar or want a longer phallus with more girth; however, this can often result in a disproportionately large or bulky neophallus [ 26 , 31 ]. An advantage to ALTF is that the anterolateral thigh skin is a better colour match to the perineum, which is especially important for patients with pigmented skin [ 30 ].…”

“…Urethral complications occur in one-third of all patients, but over three-quarters of patients are capable of voiding while standing [ 34 ]. Urethral complications are mainly fistulae and strictures, which are commonly the cause of revision surgery [ 31 , 34 ]. Fistulae commonly occur at points of anastomosis, while strictures occur at watershed areas of decreased blood supply [ 26 , 35 ].…”

Penile Diseases and Dysmorphisms (Phimosis, Frenulum, Micropenis, and Buried Penis)

“…The first series was reported in the early 1970s, and in the following decades, advances in penile reconstruction surgery have been described [40]. The harvesting of a fasciocutaneous neophallus on a free flap on the radial artery or anterolateral thigh flap (ALT) has been reported with satisfactory outcomes, and more recently, the osteocutaneous fibula flap, the free scapular flap, the suprapubic abdominal wall flap, and the vertical rectus abdominis flap have been proposed as surgical options for the treatment of micropenis [41,42]. The radial forearm free flap is the gold standard site to penile reconstruction surgery, mostly applied in female to male transsexualism, which consists in a microsurgical dissection of a radial forearm flap, possibly the nondominant arm should be chosen for flap harvest, and construction of a tube-within-a-tube phallus while the flap is still pedicled to the forearm [41,43,44] (Fig.…”