Leriche Albert, Timsit Marc-Olivier, Morel-Journel Nicolas, Bouillot André, Dembele Diala, Ruffion Alain
Department of Urology, Henry Gabrielle Hospital, University of Lyon I, Lyon, France.
BJU Int. 2008 May;101(10):1297-300. doi: 10.1111/j.1464-410X.2007.07362.x. Epub 2008 Jan 8.
To assess the long-term outcome of forearm free-flap phalloplasty in transsexuals, as obtaining a satisfying neophallus in female-to-male transsexuals is a surgical challenge.
We analysed retrospectively 56 transsexuals who had a phalloplasty using a radial forearm free-flap in our department from 1986 to 2002. The complication rate was assessed by regular examination. Patient satisfaction was evaluated by a questionnaire about cosmetic aspects, sexual life and overall satisfaction.
The mean follow up was 110 months; 53 of the 56 patients (95%) currently have a neophallus, after a mean of six surgical procedures. Satisfaction was assessed in 53 patients using a specific questionnaire: 51 (93%) of the patients reported that the phalloplasty allowed them to accord their physical appearance with their feeling of masculinity. There were flap complications in 14 patients (25%); three (5%) flaps were lost, with one each due to early haematoma, cellulitis and late arterial thrombosis. The other 11 flap complications were all transitory, e.g. infection, haematomas and vascular thrombosis. There were prosthesis complications in 11 of 38 patients (29%). Moreover, seven of 19 patients (37%) who had a urethroplasty presented with complex strictures and fistulae that led to perineal urethrostomy.
Our study shows that phalloplasty with a forearm free-flap leads to good results in term of flap survival and patient satisfaction. However, there was a high rate of complications. Patients must be clearly informed that the procedure can seldom be achieved in one stage.
评估前臂游离皮瓣阴茎再造术在变性者中的长期效果，因为在女性变男性的变性者中获得满意的新阴茎是一项外科挑战。
我们回顾性分析了1986年至2002年在我院接受桡侧前臂游离皮瓣阴茎再造术的56例变性者。通过定期检查评估并发症发生率。通过一份关于美容方面、性生活和总体满意度的问卷来评估患者满意度。
平均随访110个月；56例患者中有53例（95%）目前拥有新阴茎，平均经历了6次外科手术。使用特定问卷对53例患者进行了满意度评估：51例（93%）患者报告阴茎再造术使他们的外貌与男性气质相匹配。14例患者（25%）出现皮瓣并发症；3例（5%）皮瓣坏死，分别因早期血肿、蜂窝织炎和晚期动脉血栓形成各1例。其他11例皮瓣并发症均为暂时性的，如感染、血肿和血管血栓形成。38例患者中有11例（29%）出现假体并发症。此外，19例接受尿道成形术的患者中有7例（37%）出现复杂狭窄和瘘管，导致会阴尿道造口术。
我们的研究表明，前臂游离皮瓣阴茎再造术在皮瓣存活和患者满意度方面取得了良好效果。然而，并发症发生率较高。必须明确告知患者该手术很少能一期完成。
