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DOI: 10.1055/s-0030-1267215
© Georg Thieme Verlag KG Stuttgart · New York
Penile Reconstruction with the Radial Forearm Flap: An Update
Penis-Rekonstruktion mit A. radialis-LappenplastikPublication History
received 16.6.2010
accepted 13.9.2010
Publication Date:
11 August 2011 (online)
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.
Patients and 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.
Conclusion: 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.
Zusammenfassung
Einleitung: Viele Methoden und viele freie oder gestielte Lappenplastik werden zur Phalloplastik eingesetzt. Keine dieser Techniken kann die gut definierten Zielvorgaben der Peniskonstruktion vollständig erfüllen. Bis heute ist die A. radialis-Lappenplastik der am häufigsten genutzte Lappen und wird generall als Gold-Standard angesehen.
Patienten und Methoden: Mit 316 radialen Unterarm Phalloplastiken seit 1992 präsentieren wir die umfangreichste Serie, die bis heute von einem einzelnen chirurgischen Team durchgeführt wurde. Anhand dieser umfangreichen Daten beurteilen wir kritisch, in wie weit der aktuelle Gold-Standard die Erfordernisse einer idealen Penis-Konstruktion erfüllt.
Ergebnisse: Wir bewerteten die folgenden Outcome Parameter: erforderliche Anzahl chirurgischer Interventionen bis zur vollständigen Funktionalität, ästhetisches Ergebnis, taktiles und erogenes Empfinden, Harnentleerung, Morbidität an der Donorseite, Skrotoplastik und Geschlechtsverkehr.
Schlussfolgerung: Obschon es aktuell keine randomisierten kontrollierten Studien gibt, die beweisen dass, die A. radialis-Lappenplastik tatsächlich der Gold-Standard zur Penis-Rekonstruktion ist, unterstützt unsere retrospektive Datenanalyse unserer Meinung nach, das die radiale Unterarm Phalloplastie eine sehr zuverlässige Technik zur Bildung eines normal aussehenden Penis und Skrotums ist. Volle Funktionalität wird durch ein Minimum von 2 Operationen erreicht, die Miktion ist stehend möglich, und zumeist kann auch sexuelle Befriedigung erlebt werden. Die relativen Nachteile dieser Technik sind die zurückbleibende Narbe am Unterarm, die eher hohe Anzahl initialer Harnfisteln, die Möglichkeit langwieriger urologischer Komplikationen und der Bedarf eines Versteifers oder einer Erektionsprothese. Unserer Erfahrung nach ist eine strukturierte multidisziplinäre Kooperation zwischen dem rekonstruktiv-plastischen Chirurgen und den Urologen eine absolute Voraussetzung, um bestmögliche technische Ergebnisse zu erzielen.
Key words
Transsexuality - urological plastic surgery - arteries - genitalia
Schlüsselwörter
Transsexualismus - urologische plastische Chirurgie - Arterien - Genitalien
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Correspondence
Prof. Dr. Stan Monstrey
Department of Plastic Surgery
Gent University Hospital
De Pintelaan 185
B 9000 Gent
Belgium
Email: stan.monstrey@ugent.be