Total Phalloplasty With Latissimus Dorsi Musculocutaneous Flap in Female-to-male Transgender Surgery

Jun, Min Suk; Pušica, Slavica; Kojović, V.; Bizic, M.; Stojanovic, Borko; Krstic, Zoran; Korac, G.; Djordjević, Miroslav L.

doi:10.1016/j.urology.2018.06.032

Cited by 18 publications

(17 citation statements)

References 3 publications

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“…Though optimal recipient vessel selection is crucial for any free-flap reconstruction, [18][19][20][21][22][23][24] this topic has been neglected in most phalloplasty reports, 25 which only describe the FA and GSV as recipient vessels. 8,10,11,15,[26][27][28][29][30][31] In one of the only available studies discussing alternative recipient vessel choices, 25,39 Danker et al 25 discuss the DIEV's reliability as an adjunct to the GSV for venous outflow, with improvement of outcomes after adding the DIEV. From our literature search, no reports have described phalloplasty outcomes using the DIEV as the primary source of venous drainage.…”

Section: Discussionmentioning

confidence: 99%

“…Proper recipient vessel selection is crucial for all free flaps, [18][19][20][21][22][23][24] but literature explaining phalloplasty recipient vessel selection is extremely limited. 25 Most phalloplasty descriptions 8,10,11,15,[26][27][28][29][30][31] highlight the femoral artery (FA) and great saphenous vein (GSV) as recipi-When alternatives to the FA, including the deep inferior epigastric artery and its venae comitantes (DIEA/V), are mentioned, only cursory attention is paid to technique and selection rationale. 12,33,34 Danker et al 25 published one of the only reports discussing specific technique and outcomes using DIEA/V.…”

Section: Introductionmentioning

confidence: 99%

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Primary Use of the Deep Inferior Epigastric Pedicle for Free-flap Phalloplasty: Rationale, Technique, and Outcomes

Yuan

Ray

Smith

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Most free-flap phalloplasty reports describe the femoral artery and great saphenous vein as recipient vessels, with the deep inferior epigastric artery and venae comitantes (DIEA/V) only rarely reported. We review our experience with preferentially using the DIEA/V as recipient vessels in gender-affirming free-flap phalloplasty, with DIEV as primary venous outflow. Methods: We retrospectively reviewed consecutive patients who underwent gender-affirming free-flap phalloplasty at our single institution from June 2017 through June 2021. The DIEA/V was used as recipient vessels, with the DIEA/V pedicle externalized via a passageway made through the external inguinal ring. Results: Thirty-eight consecutive free flaps (26 radial forearm free-flap phalloplasties, 10 anterolateral thigh phalloplasties, and two radial forearm free-flap urethroplasties) were performed. Mean age was 37.3 years; mean BMI was 25.7. Mean follow-up was 17.9 months. All flaps were anastomosed to the DIEA/V, without use of vein grafts. Most flaps (89.5%) had at least two veins anastomosed. To augment outflow, a saphenous vein branch was used in one of 38 (2.6%) cases and other superficial veins were used in two of 38 (5.3%) cases. One of 38 (2.6%) cases (early in our experience) resulted in total flap loss. Conclusions: Advantages of the DIEA/V as free-flap phalloplasty recipient vessels include a short, direct pathway for vessels, excellent donor-recipient vessel size match that allows end-to-end anastomoses, and elimination of risks associated with arterialized interposed veins. When venous outflow appears compromised, we recommend a low threshold to use additional local or saphenous veins, though this is rarely needed given the DIEV’s reliability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Use of the Deep Inferior Epigastric Pedicle for Free-flap Phalloplasty: Rationale, Technique, and Outcomes

Yuan

Ray

Smith

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…It is a large flap that promotes a hidden scar. The main disadvantages of this flap is the absence of innervation, and the fact it does not allow tube-within-a-tube approach to create penile urethra, necessary for urethra lengthening, and requires at least two-stage reconstructions (28). There have been reports of the "paradox erection" that allows patients to have sexual intercourse.…”

Section: Discussionmentioning

confidence: 99%

Surgical techniques of phalloplasty in transgender patients: a systematic review

Boczar¹,

Huayllani²,

Saleem³

et al. 2021

Ann Transl Med

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Gender confirmation surgery has a crucial role among transgender individuals. Phalloplasty is a procedure that uses flaps for phallic shaft creation. Flaps can be classified in free flaps or pedicle flaps and can be obtained from different donor sites such as forearm, thigh, abdomen, groin, and leg, and upper back.We conducted a systematic review about surgical flaps for phallic shaft creation in transgender patients.A systematic review was conducted on PubMed/MEDLINE, Cochrane Clinical Answers, and Cochrane Central Register of Controlled Trials databases without timeframe limitations. Exclusion criteria included articles that reported phalloplasty on patients other than transgender, as well as other surgical techniques such as urethroplasty, vaginectomy, hysterectomy and studies focused on psychosocial outcomes. Two hundred twenty-eight potential articles were identified in the initial search. Forty-one studies fulfilled the inclusion and exclusion criteria. Surgical flaps for phallic shaft creation in transgender patients were reported on 1,391 cases. Microsurgical flaps were the most common (24 of 33). The flap technique most frequently described was radial forearm flap (15 of 33) followed by Anterolateral thigh flap (7 of 33), Latissimus dorsi flap (5 of 33), abdominal flap (4 of 33), fibular flap (3 of 33), and groin flaps (3 of 33). The literature on surgical flaps for phallic shaft creation in transgender patients reflected how challenging the reconstruction of the phallus is. In summary, there is no universal choice of flap that could be applied to every patient. Therefore, the surgical approach must be chosen considering surgeon experience, physical examination, and patient desire. We hope this review supports future studies on surgical flaps for phallic shaft creation in transgender patients.

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“…He reported a weak, continuous urinary stream, with no hesitancy, nocturia or urgency. In 2014 the patient had underwent a "female-to-male" sex change operation with a total phalloplasty with a latissimus dorsi musculocutaneous flap [4].…”

Section: Case Reportmentioning

confidence: 99%

Can ultrasonography be useful in the diagnosis of urethral disorders of female-to-male transsexuals?

2019

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Sonourethrography (SUG) is one of the basic imaging tools in the diagnosis of male anterior urethral strictures. So far, no one has described the use of this examination in transgender patients after “female-to-male” operation. Based on the presented case, we describe ultrasonographical features of the construction of a neophallus and offer information allowing a more accurate evaluation of urethral disorders in this group of patients

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Total Phalloplasty With Latissimus Dorsi Musculocutaneous Flap in Female-to-male Transgender Surgery

Cited by 18 publications

References 3 publications

Primary Use of the Deep Inferior Epigastric Pedicle for Free-flap Phalloplasty: Rationale, Technique, and Outcomes

Primary Use of the Deep Inferior Epigastric Pedicle for Free-flap Phalloplasty: Rationale, Technique, and Outcomes

Surgical techniques of phalloplasty in transgender patients: a systematic review

Can ultrasonography be useful in the diagnosis of urethral disorders of female-to-male transsexuals?

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