Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals

SummaryGender reassignment operations in female-to-male transsexuals are increasing in number as the skill of phalloplasty develops. The authors are performing phalloplasty 1 year after undergoing mastectomy, reduction of nipples, oophrectomy and hysterectomy in female-to-male transsexuals.The ideal penile reconstruction should be a single-stage procedure, creating a phallus with both tactile and erogenous sensibility, water-tight neourethra allowing for voiding in the standing position, enough bulk with stiffness, and an aesthetically acceptable appearance.We performed phalloplasty with radial forearm osteocutaneous free flaps on 40 female-to-male transsexual patients from March 1991 to December 2005. We investigated the results with regard to aesthetic and functional status and complications through physical examinations and interviews over a period of 14 years.The results are as follows:1.Fistula on the neourethra is the most frequent and troublesome complication.2.The autogenous bone or cartilage seems to be a reliable stiffener in the construction of the phallus.3.Erogenous sensibility of the constructed phallus was relatively good.4.The benefits of phalloplasty with radial forearm free flaps include the fact that it is a single stage procedure, acceptable aesthetic appearance, enough bulk and length, good sensation and the feasibility of inserting a stiffener in the penile shaft.In conclusion, we have been able to construct a good phallus with radial forearm osteocutaneous free flaps that is aesthetically and functionally acceptable. In addition, complications have been minimal.