Modifications of the radial forearm flap phalloplasty for female-to-male gender reassignment.
The radial forearm flap remains the preferred technique for phalloplasty. From 1999 to 2009, 19 patients with primary female transsexualism underwent gender reassignment surgery at our center. The radial forearm flap phalloplasty is modified as a two-stage procedure, with prelamination of the neourethra on the donor forearm before microsurgical transfer 3 months later. At 5-year follow-up, patients were asked to complete a survey on the functional, aesthetic, and psychological results postsurgery. The radial forearm flap reliably provided sufficient bulk with stiffness for the neophallus with acceptable aesthetic appearance. We further describe technical modifications to reduce the rate of urethral strictures and fistulas. None of the patients regretted undergoing gender transformation. Patients are satisfied with the surgical result and generally prepared to accept its potential costs, in view of the significant psychological and legal benefits.
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore. colin.song@sgh.com.sg
Colin
C
Song
Manzhi
M
Wong
Chin-Ho
CH
Wong
Yee-Siang
YS
Ong
D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D057830:Gender-Affirming Surgery / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D014189:Transsexualism / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*