RSS-Feed abonnieren
DOI: 10.1055/s-0041-1732373
Flap Selection Algorithm Based on the Body Mass Index for Phalloplasty in Female-to-Male Transgender: Techniques and Outcomes
Abstract
Background Various phalloplasty methods have been reported; however, a consensus has not been reached. Therefore, we suggest an alternative algorithm for an ideal phalloplasty considering the factors that affect flap selection.
Methods We retrospectively examined 32 phalloplasty cases of female-to-male transgender. Flaps used for phalloplasty were classified into three groups as follows: (1) radial forearm (RF) group, (2) anterolateral thigh (ALT) group, and (3) flap combination (FC) group. Statistical analyses were performed to determine the significance of age and body mass index (BMI) as well as differences in the rates of postoperative complication, reoperation, esthetic acceptability, tactile or erogenous sensibility, and the ability to urinate while standing.
Results Ten cases were included in the RF group and 7 and 15 cases in the ALT and FC groups, respectively. With respect to BMI, the RF group (mean [standard deviation (SD)] = 25.9 [3.3]) showed significantly higher BMI than the ALT (21.7 [0.9]) or FC group (22.2 [4.5]). The RF (mean [SD] = 3.7 [0.4]) and ALT groups (3.5 [0.9]) had significantly higher esthetic acceptability evaluation scores (from 1 to 4) than the FC group (2.5 [1.2]). Moreover, the RF and ALT groups were superior than the FC group in terms of tactile or erogenous sensibility rates.
Conclusion BMI effected flap choices for phalloplasty because of the correlation between BMI and skin thickness. FC becomes an option between ALT flap and RF flap in terms of flap choice based on BMI. Our alternative algorithm for an ideal phalloplasty based on BMI will be useful for objective flap choices.
Publikationsverlauf
Eingereicht: 02. November 2020
Angenommen: 07. Mai 2021
Artikel online veröffentlicht:
22. Juli 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Bogoras N. Uber die volle plastische Wiederherstellung eines zum koitus fahigen penis. Zentralbl Chir 1936; 22: 1271-1276
- 2 Maltz M. Maltz Reparative Technique for the Penis. New York, NY: Froben Press; 1946: 278-279
- 3 Gillies H, Harrison RJ. Congenital absence of the penis. Br J Plast Surg 1948; 1 (01) 8-28
- 4 Chappell BS. Utilization of scrotum in reconstruction of penis. J Urol 1953; 69 (05) 703-707
- 5 Kaplan I, Wesser D. A rapid method for constructing a functional sensitive penis. Br J Plast Surg 1971; 24 (04) 342-344
- 6 Orticochea M. A new method of total reconstruction of the penis. Br J Plast Surg 1972; 25 (04) 347-366
- 7 Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg 1984; 74 (02) 251-258
- 8 Gilbert DA, Horton CE, Terzis JK, Devine Jr CJ, Winslow BH, Devine PC. New concepts in phallic reconstruction. Ann Plast Surg 1987; 18 (02) 128-136
- 9 Harashina T, Inoue T, Tanaka I, Imai K, Hatoko M. Reconstruction of penis with free deltoid flap. Br J Plast Surg 1990; 43 (02) 217-222
- 10 Semple JL, Boyd JB, Farrow GA, Robinette MA. The “cricket bat” flap: a one-stage free forearm flap phalloplasty. Plast Reconstr Surg 1991; 88 (03) 514-519
- 11 Upton J, Mutimer KL, Loughlin K, Ritchie J. Penile reconstruction using the lateral arm flap. J R Coll Surg Edinb 1987; 32 (02) 97-101
- 12 Sadove RC, Sengezer M, McRoberts JW, Wells MD. One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap. Plast Reconstr Surg 1993; 92 (07) 1314-1323 , discussion 1324–1325
- 13 Lai C-S, Chou C-K, Yang CC, Lin SD. Immediate reconstruction of the penis with an iliac flap. Br J Plast Surg 1990; 43 (05) 621-624
- 14 Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 2006; 59 (02) 153-157
- 15 Namba Y, Watanabe T, Kimata Y. Flap combination phalloplasty in female-to-male transsexuals. J Sex Med 2019; 16 (06) 934-941
- 16 Monstrey S, Hoebeke P, Selvaggi G. et al. Penile reconstruction: is the radial forearm flap really the standard technique?. Plast Reconstr Surg 2009; 124 (02) 510-518
- 17 Hasegawa K, Namba Y, Kimata Y. Phalloplasty with an innervated island pedicled anterolateral thigh flap in a female-to-male transsexual. Acta Med Okayama 2013; 67 (05) 325-331
- 18 Heston AL, Esmonde NO, Dugi III DD, Berli JU. Phalloplasty: techniques and outcomes. Transl Androl Urol 2019; 8 (03) 254-265
- 19 Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Phalloplasty: a review of techniques and outcomes. Plast Reconstr Surg 2016; 138 (03) 594-615
- 20 Matsumoto Y, Abe T, Ikeda K. et al; The Japanese Society of Psychiatry and Neurology. The diagnostic and therapeutic guidelines for patients with gender identity disorder [in Japanese]. Seishin Shinkeigaku Zasshi 2012; 114 (11) 1250-1266
- 21 Frey JD, Poudrier G, Chiodo MV, Hazen A. A systematic review of metoidioplasty and radial forearm flap phalloplasty in female-to-male transgender genital reconstruction: is the “ideal” neophallus an achievable goal?. Plast Reconstr Surg Glob Open 2016; 4 (12) e1131
- 22 Murakami M, Hikima R, Arai S, Yamazaki K, Iizuka S, Tochihara Y. Short-term longitudinal changes in subcutaneous fat distribution and body size among Japanese women in the third decade of life. Appl Human Sci 1999; 18 (04) 141-149
- 23 Saito H, Tamura T. Fat distribution in Japanese women. Part 2. Fat thickness of extremities and classification of fat distribution of whole body [in Japanese]. Ann Physiol Anthropol 1994; 13 (04) 183-196