[The radial forearm phalloplasty with prelaminated urethra: a report of our learning curve during the last 6 years].

Several methods for complete phalloplasty are reported in the current literature. However, a unique technique has not been established in specialized centers so far. The radial forearm phalloplasty and the free fibular flap are the most common procedures for neophallus construction. There are 3 modifications for the radial forearm flap: the double folded "tube into tube" flap with a central vascularized urethra, the radial forearm flap with a vascularized urethra in the ulnar part of the flap and the radial forearm phalloplasty with a prelaminated neo-urethra using a full thickness skin graft. A series of 19 phalloplasties was performed between 2003 and 2010 in our department. The first cases of the series were conducted using the "tube-into-tube-technique" with the central urethra. However, the surgical concept was changed for the majority of cases (n=15) due to complications and not satisfying esthetic results. The phalloplasties were performed using the technique with a prelaminated urethra from 2005 on. The urethra prelamination was carried out using a full thickness skingraft 6 months before the actual phalloplasty procedure. Skin harvest was performed during mastectomy in the ideal case but otherwise alternatively from the lower belly. The complication rate in our series was comparable to the results of other authors. The esthetic results were very satisfying and the donor side morbidity was kept as minor as possible. All other techniques for radial forearm phalloplasty require the elevation of an additional 3.5-4 cm wide and 14-18 cm long adipocutaneous stripe at the forearm, which is used for construction of the urethra.