title: Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation.
abstract: BACKGROUND
  The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male.
  
  
  METHODS
  A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later.
  
  
  RESULTS
  During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10hours and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the aesthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration.
  
  
  CONCLUSIONS
  Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customised prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.
authors.affiliation: Departamento Clínico, Facultad de Ciencias Biomédicas, Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, España. Electronic address: jangulo@futurnet.es.
authors.forename: J C
authors.initials: JC
authors.lastname: Angulo
authors.affiliation: Departamento Clínico, Facultad de Ciencias Biomédicas, Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Arance
authors.affiliation: Zephyr Surgical Implants, Ginebra, Suiza.
authors.forename: C
authors.initials: C
authors.lastname: Gómez-Llorens
authors.affiliation: Departamento Clínico, Facultad de Ciencias Biomédicas, Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Esquinas
authors.affiliation: Servicio de Cirugía Plástica, Hospital Universitario de Getafe, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Gómez-Martín
authors.affiliation: Servicio de Cirugía Plástica, Hospital Universitario de Getafe, Madrid, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Fernández-Cañamaque
mesh_terms: D005542:Forearm / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015917:Penile Prosthesis; D010413:Penis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Amputación peneana; Colgajo libre de antebrazo radial; Faloplastia; Penile amputation; Penile prosthesis; Phalloplasty; Prótesis peneana; Radial forearm free flap