title: [Phalloplasty in female-to-male transsexuals: experience from 259 cases].
abstract: BACKGROUND
  The free radial forearm flap is state of the art for a phalloplasty in female-to-male transsexuals. Alternatives are the free fibula flap or the pedicled groin flap.
  
  
  METHODS
  In a retrospective study, 269 phalloplasties performed between 1993 and 2009 were analysed for success rates and complications. The operative technique for the radial forearm flap in 2 designs and the groin flap penile reconstruction are described.
  
  
  RESULTS
  Indications for penile reconstruction were transsexualism in 96.3%. We used 135 radial forearm flaps, 119 groin flap reconstructions, 2 fibula, one scapula and 2 pedicled randomised flaps. Of the radial forearm flaps, 10 flaps had a thrombosis (3 arterial, 4 venous, 3 combined) on postoperative day 0, 1 (n=5), 4, 4, 5 and 24. Six revisions were successful; 4 flaps failed (3%). 12 flaps (9%) showed a partial or superficial necrosis which required an operative revision.
  
  
  CONCLUSIONS
  The radial forearm flap can be performed in various designs. If the patient wishes a glans plasty the Gottlieb design is favoured. In obese patients with a short forearm the Chang design is recommended as it provides a sufficient pedicle length for anastomosis without a venous interpositional graft. The radial forearm flap has a high success rate, but late thromboses and partial necrosis are particular problems. Surgically, we recommend a trapezoid design, a skin graft if there is any sign of tension, a subfascial dissection and sufficient subcutaneous veins for drainage of the ulnar urethra. The groin flap penile reconstruction is a rare alternative for patients who wish a larger bulk, refuse to accept a stigmatising scar on the forearm and whose priority is not voiding while standing.
authors.affiliation: Markus Krankenhaus, Klinik für Plastische- und Rekonstruktive Chirurgie, Handchirurgie, Frankfurt. stbaumeister@yahoo.com
authors.forename: S
authors.initials: S
authors.lastname: Baumeister
authors.forename: M
authors.initials: M
authors.lastname: Sohn
authors.forename: C
authors.initials: C
authors.lastname: Domke
authors.forename: K
authors.initials: K
authors.lastname: Exner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012611:Scrotum / Q000601:surgery; D057830:Gender-Affirming Surgery / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D014189:Transsexualism / Q000601:surgery*; D014521:Urethra / Q000601:surgery; D014621:Vagina / Q000601:surgery; D055815:Young Adult