Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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The Etiology and Treatment of the Softened Phallus after the Radial Forearm Osteocutaneous Free Flap Phalloplasty

  • Kim, Seok-Kwun (Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine) ;
  • Kim, Tae-Heon (Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine) ;
  • Yang, Jin-Il (Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine) ;
  • Kim, Myung-Hoon (Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine) ;
  • Kim, Min-Soo (Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine) ;
  • Lee, Keun-Cheol (Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine)
  • Received : 2012.01.26
  • Accepted : 2012.05.08
  • Published : 2012.07.15
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Abstract

Background The radial forearm osteocutaneous free flap is considered to be the standard technique for penile construction. One year after their operation, most patients experience a softened phallus, so that they suffer from difficulties in sexual intercourse. In this report, we present our experience with phalloplasty by radial forearm osteocutaneous free flap, as well as an evaluation of the etiology and treatment of the softened phallus. Methods Between March 2005 and February 2010, 58 patients underwent phalloplasty by radial forearm osteocutaneous free flap. Most of their neophallus had been softened subjectively and among them, 12 patients who wanted correction were investigated. We performed repetitive fat injection, artificial dermis grafting, silicone rod insertion, and rib bone with cartilaginous tip graft. Physical examination, plain radiograph, computed tomography, bone scintigraphy, and satisfaction scores were investigated. Results Most of the participants' penises have been softened after phalloplasty, and the skin elasticity had been also decreased. On plain radiograph, the distal end of the bone was self-rounded; however, the bone shape of the neophallus had no significant interval changes or resorption. Computed tomography showed equivocal density of cortical bone. On bone scintigraphy, the bone metabolism was active at 3 months postoperatively, and remained active 9 years postoperatively. Conclusions The use of a rib bone with cartilaginous tip graft could be an option for improvement of the softened phallus. Silicon rod insertion is also worth considering for rigidity of the softened phallus. Decreased rigidity due to soft tissue atrophy could be alleviated with repeated fat injection and artificial dermis grafting.

Keywords

Acknowledgement

Supported by : Dong-A University

References

  1. Monstrey S, Hoebeke P, Selvaggi G, et al. Penile reconstruction: is the radial forearm flap really the standard technique? Plast Reconstr Surg 2009;124:510-8. https://doi.org/10.1097/PRS.0b013e3181aeeb06
  2. Kim SK, Lee KC, Kwon YS, et al. Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals. J Plast Reconstr Aesthet Surg 2009;62:309-17. https://doi.org/10.1016/j.bjps.2007.11.011
  3. Sadove RC, Sengezer M, McRoberts JW, et al. One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap. Plast Reconstr Surg 1993;92:1314-23.
  4. Yang M, Zhao M, Li S, et al. Penile reconstruction by the free scapular flap and malleable penis prosthesis. Ann Plast Surg 2007;59:95-101. https://doi.org/10.1097/01.sap.0000253745.07940.da
  5. Perovic SV, Djinovic R, Bumbasirevic M, et al. Total phalloplasty using a musculocutaneous latissimus dorsi flap. BJU Int 2007;100:899-905. https://doi.org/10.1111/j.1464-410X.2007.07084.x
  6. Vesely J, Hyza P, Ranno R, et al. New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals. Ann Plast Surg 2007;58:544-50. https://doi.org/10.1097/01.sap.0000245123.16757.15
  7. Hage JJ, van Turnhout AA. Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals. Ann Plast Surg 2006;57:312-6. https://doi.org/10.1097/01.sap.0000221625.38212.2e
  8. Schaff J, Papadopulos NA. A new protocol for completephalloplasty with free sensate and prelaminated osteofasciocutaneous flaps: experience in 37 patients. Microsurgery 2009;29:413-9. https://doi.org/10.1002/micr.20647
  9. Kim SK, Moon JB, Heo J, et al. A new method of urethroplasty for prevention of fistula in female-to-male gender reassignment surgery. Ann Plast Surg 2010;64:759-64. https://doi.org/10.1097/SAP.0b013e3181a5b719
  10. Papadopulos NA, Schaff J, Biemer E. Long-term fate of the bony component in neophallus construction with free osteofasciocutaneous forearm or fibula flap in 18 female-tomale transsexuals. Plast Reconstr Surg 2002;109:1025-30. https://doi.org/10.1097/00006534-200203000-00035
  11. Patwardhan SK, Shah R, Kulkarni V, et al. Shah's Indian penile prosthesis placement after phallic reconstruction with radial forearm flap. Indian J Urol 2008;24:107-8. https://doi.org/10.4103/0970-1591.38613
  12. Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg 1984;74:251-8. https://doi.org/10.1097/00006534-198408000-00014
  13. Hoebeke P, de Cuypere G, Ceulemans P, et al. Obtaining rigidity in total phalloplasty: experience with 35 patients. J Urol 2003;169:221-3. https://doi.org/10.1016/S0022-5347(05)64072-4

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