Pol Merkuriusz Lek 2001 Jan;10(55):27-30

[Evaluation of surgical flaps used for creation of an artificial penis in female-male type transsexuals].
[Article in Polish]
Zielinski T.
Klinika Chirurgii Plastycznej Instytutu Chirurgii AM w Lodzi.

In the years 1983-1997, 252 female to male transsexuals were treated in the Department of Plastic Surgery of University Medical School in Lodz. In 209 patients surgical penis construction was performed. The paper presents operative techniques and results of penis construction with the use of four kinds of flaps: a bipedicled abdominal tube flap, a single pedicled infraumblical flap, a pedicled myocutaneous flap with gracilis muscle and a pedicled lateral groin flap. Overall estimation of early results of penis construction with the use of the four methods applied in the Department showed that we obtained good results in 69.8% of operated transsexuals, satisfactory effects in 24.4% of patients and poor outcome in 5.8% of cases. The best results were achieved with the technique involving a lateral groin flap.
PMID: 11320547 [PubMed - indexed for MEDLINE]

Plast Reconstr Surg 2000 May;105(6):1990-1996

Neophalloplasty in female-to-male transsexuals with the island tensor fasciae latae flap.
Santanelli F, Scuderi N.
Department of Plastic Surgery, University of Rome La Sapienza, Italy. sanfabio@uniromal.it

In the past 60 years, several different procedures have attempted to achieve a postoperative neophallus that is as aesthetic and as functional as possible after penile amputation or sex reassignment. Recently, with improvements in free tissue transfer and microvascular technique, many free flap procedures have been developed with the goal of an aesthetically acceptable neophallus of adequate bulk that enables urination in a standing position and sexual intercourse, with minimal functional and aesthetic donor-site defects. Most authors currently agree that the method of choice for penile reconstruction is microsurgical free tissue transfer, although it does not always fulfill all of the aforementioned goals in a predictable manner. In fact, complete urethroplasty, penile rigidity, and donor-site disfigurement remain challenges, thus making this operation one of the most difficult in plastic surgery. The vascular anatomy of the lateral circumflex femoral artery, which we studied in 1991 with the anatomic dissection of 27 cadavers, gave us the idea to use a long tensor fasciae latae neurovascular island flap as a donor source for neophalloplasty. Grounds for the procedure and its surgical planning have been carefully evaluated with 10 additional fresh cadaver dissections. Since 1991, we have performed five neophalloplasties using this procedure; all patients were female-to-male transsexuals. In four cases, the healing was uneventful; in one case, there was a marginal necrosis of the flap because of poor venous drainage, probably from a twisting of the pedicle. The island tensor fasciae latae provides a safe and sensate flap for phalloplastic procedure and leaves a less conspicuous donor scar.
PMID: 10839396 [PubMed - indexed for MEDLINE]

J Reconstr Microsurg 1996 Jul;12(5):279-282

Salvage of a "free flap" phalloplasty by distal arteriovenous fistula: case report.
Hage JJ, Winters HA.
Department of Plastic and Reconstructive Surgery, Academic Hospital, Free University, Amsterdam, The Netherlands.

Radial forearm-flap sensate free-flap phalloplasty was performed in a 32-year-old female-to-male transsexual. An arteriovenous loop was created by end-to-side anastomosis of the left greater saphenous vein to the femoral artery at the level of the femoral triangle. On the first postoperative day, the neophallus showed signs of impaired circulation, and a recent thrombus was removed from the venous pedicle. A distal fistula between the radial artery and a superficial vein was created, converting this possibly low-flow flap to a high-flow system. The flap could be salvaged entirely. Taking the well-recognized, long-term complications of arteriovenous fistulas into account, the authors do not recommend routine use of such a distal fistula. Still, in cases where vascular patency of the venous graft is shown not to be adequate, an adjunctive arteriovenous fistula created distally may salvage the flap.
PMID: 8835825 [PubMed - indexed for MEDLINE]

Asian J Androl 2000 Dec;2(4):304-306

Penile prosthesis implantation in a transsexual neophallus.
Tan HM.
Subang Jaya Medical Centre, Subang Jaya 47500, Malaysia. apsirmal@tm.net.my

Reconstruction surgery for a female to male transsexual usually involves mastectomy, hysterectomy and creating an aesthetically appealing neophallus. We have successfully inserted an inflatable prosthesis using the AMS CX prosthesis in a 45 year old transsexual, who had a large bulky neophallus constructed from the anterior abdominal subcutaneous fat, about 9 years ago. The single cylinder CX prosthesis was well anchored to the symphysis pubis using a dacron windsock tubing, the activation pump was placed in the dependent pouch of the right labium and the reservior in the usual perivesical space. The patient subsequently had debulking procedure using liposuction to create a more aesthetic and functional phallus. To date, the inflatable neophallus prosthesis is functioning well.
PMID: 11202422 [PubMed - indexed for MEDLINE]

Acta Chir Plast 1999;41(2):39-42

Our standard method of reconstruction of the penis and urethra in female to male transsexuals.
Vesely J, Kucera J, Hrbaty J, Stupka I, Rezai A.
Clinic of Plastic and Aesthetic Surgery, St. Anne Faculty Hospital Brno, Czech Republic.

The authors used as a standard a one-stage method of microsurgical reconstruction of the penis, urethra and glans in 38 transsexual patients, a combination of Biemer's method, Trengove-Jones and Horton's suture of the glans. The reconstruction method is described in detail. Although reconstruction of the penis and urethra involved a group of 49 patients and accounted for less than 10% of all microsurgical tissue transfers in traumatology, oncological surgery and congenital defects, they are an important activity in systematic surgery.
PMID: 10439515 [PubMed - indexed for MEDLINE]

J Urol 1993 Jan;149(1):122-125

Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report.
Fisch M, Wammack R, Ahlers J, Sennerich T, Muller SC, Hohenfellner R.
Department of Urology, University of Mainz School of Medicine, Germany.

We report on a patient who had undergone female-to-male transsexual surgery and subsequent phalloplasty by means of a free latissimus dorsi muscle graft with pudendal nerve coaptation elsewhere 10 years ago. The surgical strategy for implantation and osseous fixation of a penile prosthesis is described. We discuss whether the primary implantation of a penile prosthesis during 1-stage surgical phalloplasty is more advantageous in comparison with the currently favored secondary implantation. Phalloplasty should be represented by a 1-stage surgical procedure encompassing the creation of a neourethra, restoration of tactile and possibly erogenous sensibility, and implantation of a penile prosthesis. The result should have aesthetic value and be pleasing to the patient.
PMID: 8417192 [PubMed - indexed for MEDLINE]