Total phallic reconstruction in female-to-male transsexuals.

BACKGROUND The goal of total phallic construction is the creation of a sensate and cosmetically acceptable phallus. An incorporated neourethra allows the patient to void while standing, and the insertion of a penile implant allows the patient to resume sexual activities, thus improving quality of life. OBJECTIVE To report our experience of total phallic construction with the use of the radial artery free flap in female-to-male transsexuals. DESIGN, SETTINGS, AND PARTICIPANTS The notes of the 115 patients who underwent total phallic construction with the use of the radial artery-based forearm free flap between January 1998 and December 2008 were reviewed retrospectively. MEASUREMENTS The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery, and patient satisfaction were recorded during the follow-up. RESULTS AND LIMITATIONS This technique allowed the reconstruction of a cosmetically acceptable phallus in 112 patients; 3 patients lost the phallus due to venous thrombosis in the immediate postoperative period. After a median follow-up of 26 mo (range: 1-270 mo), 97% of patients are fully satisfied with cosmesis and size of the phallus. Sensation of the phallus was reported by 86% of patients. Urethral strictures and fistulae in the phallus and join-up site were the most common complications, occurring respectively in 9 and 20 patients; however, after revision surgery, 99% of patients were able to void from the tip of the phallus while standing. CONCLUSIONS The radial artery-based forearm free flap technique is excellent for total phallic construction, providing excellent cosmetic and functional results.