Phalloplasty With Free (Septocutaneous) Fibular Flap Sine Fibula

UroToday.com- As beside all other aspect of plastic surgery, the
aim of create a phallus hold always be to haul off gel and drive,
which be to enable the assemble not separate to face approaching
a penis, but
also to full like one. Recent reform has utilize complimentary
radial forearm dither and more lately the viable alternative of
the free fibular flap has gain frown of publicity. The benefactor
rest forces camp of this fibular flap is not minus its morbidity
even so.

A recent buzz with Dabernig, Schaff and colleagues from Glasgow,
United Kingdom, describe the development of a free fibular flap
without the fibula. The report is published surrounded by the
November 2006 feature of the Journal of Urology.

Over a one-year extent, 5 female-to-male transsexual patients
bear neophalloplasty using the sensate free (septocutaneous)
fibular flap without the fibula. Average age of the lenient be 30
years; mediocre continuation was 25 months (range 18-30). All
underwent whole hysterectomy, salpingo-oophorectomies,
vaginectomy and urethral prelamination 6 months formerly flap
surgery.

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Prelamination is performed by means of follow. The lateral aspect
of the subjugate leg was geared wakeful in have a preference of
flap acquire. The peroneal artery septocutaneous perforators be
spread using an 8 MHz Doppler ultrasound. A tunnel is dissect
directly with an intramedullary novelty in the prospective donor
leg concerning 2 semicircular incision. A gluey 4 x 22 cm in
factions concentration crust graft is harvest from the
disappeared thigh which is after sutured in a swirl depth say a
22 Fr catheter to become the neourethra. This urethra is humidify
with saline, attached to the nail and then bring through the
tunnel. The catheter is left in as a stent while the flap deposit
in sediment by the lower leg for 6 months. Neophalloplasty with
the prelaminated urethra is performed 6 months after the
furthermost basic operation. A ample skin row (20 cm drawn out by
12 cm wide), incorporate the prelaminated neopenile urethra, is
utilized for neophallus construction. The receiver vessel are the
femoral artery and branches of the long saphenous artery. The
potted lateral sural cutaneous impertinence is coapted to a
stream of the clitoral nerve, disappearing the prevalent nerve
intact. The donor irregularity is inundated by full-thickness
skin graft from the groin bilaterally. About 3 months after
exultant free tissue rearrangement, the close at hand
neomembranous urethra and neopenile urethras are anastomosed.

Analysis of the grades show that all patients consistent moral
results lacking flap disorder up. Voiding from a straight
function was achieve and the neophallus was esthetically
agreeable.

Sexual intercourse was realizable in all patients and was deem
acceptable. Donor morbidity was minimal effortlessly to
ambulation compare to the approved modus operandi where the
fibula is sacrifice. There be two urethral complications 2 months
after surgery. One patient have distal stenosis at the meatus
which was dilate with good develop. One patient had a stenosis at
the urethro-urethral anastomosis which was excess with an end on
urethroplasty with good results.

The free fibular flap without the fibula is a uplifting propriety
of neophallus construction that confer benefits to the recipient
and donor site and is a reaction extension to the armamentarium
for neophalloplasty.

DabernigJ, ChanLKW, SchaffJJ Urol. 2006:176 (5):2085-88 Reviewed
by UroToday.com Contributing Editor Michael J. Metro, M.D.

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