Usefulness of Free Sensate Osteofasciocutaneous Forearm and Fibula Flaps for Neophallus Construction

ABSTRACT

Female-to-male transsexuals have been treated by the authors since the 1970's, using different operative methods. Since 1981, these patients have received neophallus construction with free sensate osteofasciocutaneous forearm flaps and, since 1993, with free sensate osteofasciocutaneous fibula flaps. In order to evaluate the usefulness of these flaps, the authors performed, in 24 patients (12 with forearm and 12 with fibula flaps), the following examinations: clinical and radiologic evaluations of the neophallus and its donor site, as well as patient questionnaires. In all patients, subjective findings and clinical examinations showed no significant variations in neophallus size and form. Patients with fibula flaps had better sexual intercourse, although their neophallus sensibility was minor, when compared to the forearm flap patients. Donor-site morbidity was moderate in both groups.

On radiologic examination, robust, calcified bone structure, and no fracture of the neophallus bone and its donor site, as well as no instability of the ankle joint (in the fibula flap patients) were found.

These findings further support the use of these free sensate osteofasciocutaneous flaps for neophallus construction. In the authors' opinion, it is the patient who must decide which method should be used for neophallus construction.

KEYWORD

construction - free sensate osteofasciocutaneous forearm - fibula flaps

REFERENCES

• 1 Bogoras N. Über die volle plastische Wiederherstellung eines zum Koitus fähigen Penis (Peniplastica totalis).  Zentralbl Chir . 1936;  22 1271
• 2 Blum V. A case of plastic restoration of the penis.  J Mt Sinai Hosp . 1938;  4 506
• 3 Maltz M. Maltz technique. In: Maltz M Evolution of Plastic Surgery. New York: Froben Press 1946
• 4 Gillies H, Harrison R J. Congenital absence of the penis with embryological considerations.  Br J Plast Surg . 1948;  1 8
• 5 Gillies H, Millard Jr R D. The Principles and Art of Plastic Surgery.  London: Butterworth 1957
• 6 Weissbach L, Tümmers H, Gharid M. Die operative Korrektur des intersexuellen äußeren Genitales in die männliche Richtung.  Gynaekologe . 1976;  9 83
• 7 McGregor I A, Jackson I T. The groin flap.  Br J Plast Surg . 1972;  25 3
• 8 Hoopes J E. Surgical construction of the male external genitalia.  Chir Plast Surg . 1974;  1 325
• 9 Puckett C L, Montie J E. Construction of the male genitalia in the transsexual, using a tubed groin flap for the penis and a hydraulic inflation device.  Plast Reconstr Surg . 1978;  61 523
• 10 Orticochea M. A new method of total reconstruction of the penis.  Br J Plast Surg . 1972;  25 347
• 11 Hage J J, Bloem J A M J, Suliman H M. Review of the literature on techniques for phalloplasty with emphasis on the applicability in female-to-male transsexuals.  J Urol . 1993;  150 1093
• 12 Biemer E. Bedeutung und Fortschritte der chirurgischen Geschlechtsumwandlung.  Muench Med Wschr . 1988;  130 480
• 13 Biemer E. Das Problem des Transexualismus. In: Krupp S: Plastische Chirurgie: Klinik und Praxis Landsberg, Ecomed, 1994
• 14 Song R Y, Song Y, Yu Y. The forearm flap.  Chir Plast Surg . 1982;  9 21
• 15 Stock W, Mühlbauer W, Biemer E. Der neurovaskuläre Unterarm - Insel - Lappen.  Plast Chir . 1981;  5 158
• 16 Biemer E. Penile construction by the radial arm flap.  Clin Plast Surg . 1988;  15 425
• 17 Sadove R C, Sengezer M, Roberts J W, Wells M D. One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap.  Plast Reconstr Surg . 1993;  92 1314
• 18 Papadopulos N, Schaff J, Fuchs C. Bone structure variations by free osteofasciocutaneous forearm and fibula flaps for penoid construction. Personal communication at the 3rd Congress of the European Federation of Societies for Microsurgery in Berlin, Germany, April 17-19, 1996
• 19 Papadopulos N A, Schaff J, Biemer E. Long-term fate of the bony component in neophallus construction with free osteofasciocutaneous forearm and fibula flaps in 18 transsexuals.  Plast Reconstr Surg 2001 (in press).
• 20 Hage J J, Bloem J A M J, Bouman F G. Obtaining rigidity in the neophallus of female-to-male transsexuals: a review of the literature.  Ann Plast Surg . 1993;  30 327
• 21 Hage J J, Winters H A, Van Lieshout J. Fibula free flap phalloplasty: modifications and recommendations.  Microsurgery . 1996;  17 358
• 22 Capelouto C C, Orgill D P, Loughlin K R. Complete phalloplasty with a prelaminated osteocutaneous fibula flap.  J Urol . 1997;  158 2238
• 23 Hage J J. Reinnervation of the cutaneous part of the free fibula osteocutaneous flap for reconstruction of the phallus.  Plast Reconstr Surg . 1993;  91 193
• 24 Hage J J. Reinnervation of the cutaneous part of a free fibula flap.  Plast Reconstr Surg . 1997;  100 277
• 25 Hage J J, Bout C A, Bloem J J, Megens J A. Phalloplasty in female-to-male transsexuals: what do our patients ask for?.  Ann Plast Surg . 1993;  30 323