title: Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism.
abstract: OBJECTIVE
  To assess the long-term outcome of forearm free-flap phalloplasty in transsexuals, as obtaining a satisfying neophallus in female-to-male transsexuals is a surgical challenge.
  
  
  METHODS
  We analysed retrospectively 56 transsexuals who had a phalloplasty using a radial forearm free-flap in our department from 1986 to 2002. The complication rate was assessed by regular examination. Patient satisfaction was evaluated by a questionnaire about cosmetic aspects, sexual life and overall satisfaction.
  
  
  RESULTS
  The mean follow up was 110 months; 53 of the 56 patients (95%) currently have a neophallus, after a mean of six surgical procedures. Satisfaction was assessed in 53 patients using a specific questionnaire: 51 (93%) of the patients reported that the phalloplasty allowed them to accord their physical appearance with their feeling of masculinity. There were flap complications in 14 patients (25%); three (5%) flaps were lost, with one each due to early haematoma, cellulitis and late arterial thrombosis. The other 11 flap complications were all transitory, e.g. infection, haematomas and vascular thrombosis. There were prosthesis complications in 11 of 38 patients (29%). Moreover, seven of 19 patients (37%) who had a urethroplasty presented with complex strictures and fistulae that led to perineal urethrostomy.
  
  
  CONCLUSIONS
  Our study shows that phalloplasty with a forearm free-flap leads to good results in term of flap survival and patient satisfaction. However, there was a high rate of complications. Patients must be clearly informed that the procedure can seldom be achieved in one stage.
authors.affiliation: Department of Urology, Henry Gabrielle Hospital, University of Lyon I, Lyon, France.
authors.forename: Albert
authors.initials: A
authors.lastname: Leriche
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Timsit
authors.forename: Nicolas
authors.initials: N
authors.lastname: Morel-Journel
authors.forename: André
authors.initials: A
authors.lastname: Bouillot
authors.forename: Diala
authors.initials: D
authors.lastname: Dembele
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
mesh_terms: D000328:Adult; D005260:Female; D005542:Forearm / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D017060:Patient Satisfaction; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D014189:Transsexualism / Q000601:surgery*; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*