Lumen N, Monstrey S, Ceulemans P, van Laecke E, Hoebeke P
Department of Paediatric Urology and Urogenital Reconstruction, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
Adv Urol. 2008;2008:704343. doi: 10.1155/2008/704343. Epub 2008 Nov 4.
Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy. Methods. Eleven males (age 15 to 42 years) were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4-49 months). Aesthetic and functional results were evaluated. Results. There were no complications related to the flap. Aesthetic results were judged as "good" in 9 patients and "moderate" in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula). Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion. Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.
目的。青少年严重阴茎发育不全较为罕见。阴茎重建术治疗这种严重疾病对重建外科医生来说是一项重大挑战。使用游离桡侧前臂皮瓣（RFF）或带蒂股前外侧皮瓣（ALTF）进行阴茎重建术已常规用于女性向男性变性者。最近我们开始将这些技术用于治疗严重阴茎发育不全。方法。11名男性（年龄15至42岁）接受了阴茎重建术。RFF是我们的首选方法；当游离皮瓣禁忌或患者不太愿意接受时，ALTF是一种替代方法。7例患者使用了RFF，4例患者使用了ALTF。平均随访25个月（范围：4至49个月）。评估美学和功能结果。结果。未出现与皮瓣相关的并发症。9例患者的美学结果被判定为“良好”，2例患者为“中等”。RFF的感觉功能优于ALTF。4例患者出现泌尿系统并发症（狭窄和/或瘘管）。6例患者接受了阴茎假体植入手术。2例患者因感染或侵蚀不得不取出阴茎假体。结论。无论何种原因导致严重阴茎发育不全，如今阴茎成形术是首选治疗方法。游离桡侧前臂皮瓣仍是首选方法。股前外侧皮瓣可以是一种很好的替代方法，尤其是在游离皮瓣禁忌时，但这些皮瓣的感觉功能明显较差。
