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DOI: 10.1055/s-0041-1740382
Musculocutaneous Latissimus Dorsi Phalloplasty
Funding This work is supported by the Ministry of Science and Technical Development, Republic of Serbia, Project No. 175048.![](https://www.thieme-connect.de/media/10.1055-s-00042863/202202/lookinside/thumbnails/10-1055-s-0041-1740382_2120983-1.jpg)
Abstract
The treatment of gender dysphoria consists of psychiatric evaluation, initiation of hormonal therapy, and the final step in an individual's transition, performing gender-affirming surgery. Construction of the neophallus is one of the most demanding tasks in genital affirming surgery of transgender men. The main objectives of phalloplasty are to achieve a cosmetically acceptable and functional phallus, with a neourethra that allows voiding in standing position, sufficient length and strength for possible penetrative intercourse, preserved tactile and orgasmic sensation, and acceptable donor site morbidity. The musculocutaneous latissimus dorsi flap has reliable and suitable anatomy (good size, volume, and length of neurovascular pedicle) to meet the esthetic and functional requirements of neophallus reconstruction. Despite many advantages, the main disadvantage of this flap is the lack of sensitivity. Although the radial free forearm flap technique is the most commonly performed procedure, musculus latissimus dorsi flap is an acceptable choice in gender-affirming surgery.
Publication History
Article published online:
24 June 2022
© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Monstrey S, Houtmeyers P, Lumen N, Hoebeke P. Radial forearm flap phalloplasty. In: Djordjevic M, Santuci R. eds. Penile Reconstructive Surgery. LAP Lambert Academic Publishing, Saarbrucken; 2012: 254-278
- 2 Coleman E, Bockting W, Botzer M. et al. 7th version of WPATH standards of care. Int J Transgenderism 2011; 13: 165-232
- 3 Gorton RN, Erickson-Schroth L. Hormonal and surgical treatment options for transgender men (female-to-male). Psychiatr Clin North Am 2017; 40 (01) 79-97
- 4 Guerrero-Fernández J, Azcona San Julián C, Barreiro Conde J. et al. [Management guidelines for disorders/different sex development (DSD)]. An Pediatr (Engl Ed) 2018; 89 (05) 315.e1-315.e19
- 5 Perovic SV, Djordjevic ML. Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU Int 2003; 92 (09) 981-985
- 6 Jun MS, Pušica S, Kojovic V. et al. Total phalloplasty with latissimus dorsi musculocutaneous flap in female-to-male transgender surgery. Urology 2018; 120: 269-270
- 7 Germann G, Öhlbauer M. Latissimus dorsi flap. In: Wei F, Mardini S. eds. Flaps and Reconstrucitve Surgery. 3rd ed.. Philadelphia, PA: WB Saunders; 2009: 287-303
- 8 Dennis M, Granger A, Ortiz A, Terrell M, Loukos M, Schober J. The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty. Clin Anat 2018; 31 (02) 152-159
- 9 Perovic SV, Djinovic R, Bumbasirevic M, Djordjevic M, Vukovic P. Total phalloplasty using a musculocutaneous latissimus dorsi flap. BJU Int 2007; 100 (04) 899-905 , discussion 905
- 10 Djordjevic ML, Bumbasirevic MZ, Vukovic PM, Sansalone S, Perovic SV. Musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children. J Pediatr Urol 2006; 2 (04) 333-339
- 11 Bizic MR, Stojanovic B, Djordjevic ML. Genital reconstruction for the transgendered individual. J Pediatr Urol 2017; 13 (05) 446-452
- 12 Djordjevic ML, Bencic M, Kojovic V. et al. Musculocutaneous latissimus dorsi flap for phalloplasty in female to male gender affirmation surgery. World J Urol 2019; 37 (04) 631-637
- 13 Bogoraz N. Plastic construction of penis capable of accomplishing coitus. Zentralbl Chir 1936; 63: 1271-1276
- 14 Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg 1984; 74 (02) 251-258
- 15 Monstrey S, Hoebeke P, Selvaggi G. et al. Penile reconstruction: is the radial forearm flap really the standard technique?. Plast Reconstr Surg 2009; 124 (02) 510-518
- 16 Djordjevic ML, Bumbasirevic MZ, Krstic Z. et al. Severe penile injuries in children and adolescents: reconstruction modalities and outcomes. Urology 2014; 83 (02) 465-470
- 17 Djordjevic ML, Bizic MR, Duisin D, Bouman MB, Buncamper M. Reversal surgery in regretful male-to-female transsexuals after sex reassignment surgery. J Sex Med 2016; 13 (06) 1000-1007
- 18 Doornaert M, Hoebeke P, Ceulemans P, T'Sjoen G, Heylens G, Monstrey S. Penile reconstruction with the radial forearm flap: an update. Handchir Mikrochir Plast Chir 2011; 43 (04) 208-214
- 19 Garaffa G, Ralph DJ. Free flap phalloplasty for female to male gender dysphoria. J Sex Med 2016; 13 (12) 1942-1947
- 20 Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 2006; 59 (02) 153-157
- 21 Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int 2005; 95 (01) 120-124
- 22 Rashid M, Tamimy MS. Phalloplasty: the dream and the reality. Indian J Plast Surg 2013; 46 (02) 283-293
- 23 Hage JJ, Bouman FG, de Graaf FH, Bloem JJ. Construction of the neophallus in female-to-male transsexuals: the Amsterdam experience. J Urol 1993; 149 (06) 1463-1468