Sasaki K, Nozaki M, Morioka K, Huang T T
Department of Plastic and Reconstructive Surgery at Tokyo Women's Medical College, Japan.
Plast Reconstr Surg. 1999 Sep;104(4):1054-8. doi: 10.1097/00006534-199909040-00024.
The use of a radial forearm flap has become the most popular method to reconstruct a phallus in recent years. This method of reconstruction, however, is plagued with problems such as urethral fistula and loss of phallic girth as a result of tissue atrophy, rendering a phallic contour that is cosmetically unsatisfactory. We had the opportunity of modifying the technique of penile reconstruction using a forearm osteocutaneous flap to minimize these problems. Specifically, a segment of the big toe pulp is used to reconstruct a glans penis. Sensory restoration in the "glans" and "penile shaft" is restored by coapting the digital and the antebrachial nerves to the penile nerve remnants. A segment of flexor carpi radialis muscle is included in the design of a forearm flap to reinforce the coaptation site of the urethral tract. An arteriovenous shunt is incorporated in the shaft as a mechanism to elicit erection of the penis by compressing the root of the neophallus. We had used these technical modifications in a 51-year-old man who had undergone penile amputation because of cancer. The cosmetic appearance and erotic and tactile sensation in the shaft and glans were proper and satisfactory at the end of fourth year after the surgery. The coital function was also satisfactory.
近年来，使用桡侧前臂皮瓣已成为重建阴茎最常用的方法。然而，这种重建方法存在诸多问题，如尿道瘘以及由于组织萎缩导致阴茎周长减小，致使阴茎外形在美观上不尽人意。我们有机会对使用前臂骨皮瓣进行阴茎重建的技术进行改良，以尽量减少这些问题。具体而言，使用一段拇趾腹重建阴茎头。通过将指神经和前臂神经与阴茎神经残端吻合来恢复“阴茎头”和“阴茎体”的感觉。在前臂皮瓣设计中纳入一段桡侧腕屈肌，以加强尿道吻合部位。在阴茎体中植入动静脉分流装置，作为通过压迫新阴茎根部来引发阴茎勃起的一种机制。我们已将这些技术改良应用于一名因癌症接受阴茎切除的51岁男性患者。术后第四年末，阴茎体和阴茎头的外观、性刺激和触觉感觉均正常且令人满意。性交功能也令人满意。
