title: Urethral reconstruction using the radial forearm free flap: experience in oncologic cases and gender reassignment.
abstract: OBJECTIVE
  Urethra reconstruction in men remains a complex problem, particularly in patients who have had previous amputation for penile tumour or who have undergone gender reassignment. Many reconstructive techniques currently in use recreate the urethra but are prone to recurrent stricture formation and fail to achieve micturition with a good stream when standing. The authors propose using the radial forearm fasciocutaneous free flap as a single-stage technique of male urethral reconstruction.
  
  
  METHODS
  During 1999-2004, nine patients underwent microsurgical reconstruction of the male urethra using the radial forearm fasciocutaneous free flap. Three patients underwent urethral reconstruction following previous subcutaneous penectomy for penile cancer. Another six patients had urethral reconstruction performed after failure of primary urethra construction as part of their gender reassignment surgery.
  
  
  RESULTS
  The average age at the time of surgery was 35.1 yr (range: 22-55 yr) and average follow-up time was 41.8 mo (range: 13-55 mo). Flap reconstruction was successful in all cases, with no instances of free flap failure; however, two patients developed significant stenosis requiring revision, and no patients had postoperative fistula formation. Therefore, the success rate for urethral reconstruction after the first operation was seven of nine. Two patients with stenosis were treated operatively to release strictures with local flaps. Uroflowmetry demonstrated that these patients had satisfactory flow rates.
  
  
  CONCLUSIONS
  Patient satisfaction and objective studies have demonstrated that urethral reconstruction with the use of radial forearm free flap is a good reconstructive procedure particularly when the patients need an extensive and long urethral reconstruction.
authors.affiliation: Plastic Surgery Center, Munich, Germany. joerg.dabernig@gmx.at
authors.forename: Jörg
authors.initials: J
authors.lastname: Dabernig
authors.forename: Odhran P
authors.initials: OP
authors.lastname: Shelley
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Cuccia
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schaff
mesh_terms: D000328:Adult; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010412:Penile Neoplasms / Q000601:surgery; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014189:Transsexualism / Q000601:surgery; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*