title: Penile reconstruction with the radial forearm flap: an update.
abstract: BACKGROUND
  Many methods and many free or pedicled flaps have been used in phalloplasty. None of these techniques is able to completely fulfill the well described goals in penile reconstruction. Still, the radial forearm glap is currently the most frequently used flap and thus universally considered the gold standard.
  
  
  METHODS
  Since 1992, we have performed the largest series of 316 radial forearm phalloplasties to date performed by a single surgical team. From these extensive data we critically evaluate how this current supposed gold standard can meet the requirements of an ideal penile reconstruction.
  
  
  RESULTS
  We assessed outcome parameters such as number of procedures to achieve complete functional result, aesthetic outcome, tactile and erogenous sensation, voiding, donor site morbidity, scrotoplasty and sexual intercourse.
  
  
  CONCLUSIONS
  While currently no controlled randomized prospective studies are available to prove the radial forearm flap is truly the 'gold standard' in penile reconstruction, we believe that our retrospective data support the radial forearm phalloplasty as a very reliable technique for the creation of a normal looking penis and scrotum. While full functionality is achieved through a minimum of 2 procedures, the patients are always able to void standing, and in most cases to experience sexual satisfaction. The relative disadvantages of this technique are the residual scar on the forearm donor site, the rather high number of initial urinary fistulas, the potential for long-term urological complications and the need for a stiffener or erection prosthesis. From our experience, we strongly feel that a structured multi-disciplinary cooperation between the reconstructive-plastic surgeon and the urologist is an absolute requisite to obtain the best possible technical results.
authors.affiliation: Department of Plastic Surgery, Gent University Hospital, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Doornaert
authors.forename: P
authors.initials: P
authors.lastname: Hoebeke
authors.forename: P
authors.initials: P
authors.lastname: Ceulemans
authors.forename: G
authors.initials: G
authors.lastname: T'Sjoen
authors.forename: G
authors.initials: G
authors.lastname: Heylens
authors.forename: S
authors.initials: S
authors.lastname: Monstrey
mesh_terms: D003299:Cooperative Behavior; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D015414:Mastectomy, Subcutaneous; D008866:Microsurgery / Q000379:methods; D010348:Patient Care Team; D015917:Penile Prosthesis; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000379:methods*; D014189:Transsexualism / Q000601:surgery*