Boucher F, Brosset S, Mojallal A A, Braye F, Chateau J, Morel Journel N
Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
Ann Chir Plast Esthet. 2017 Dec;62(6):617-624. doi: 10.1016/j.anplas.2017.03.008. Epub 2017 Apr 26.
The free radial forearm flap is considered as the gold standard in penile reconstruction for good functional and aesthetic results. The scar on donor site could be considered as pathognomonic of their situation by transsexual patients. The development of microsurgical flaps provides new therapeutic options. This options are discussed and a therapeutic algorithm is presented. The main techniques used are the pedicled anterolateral thigh perforator flap and free muscle sparing latissimus dorsi flap. Principal criteria are listed, the choice of patient and the local anatomical conditions are the most important. Antebrachial flap stay the first choice. In case of non-feasibility of this flap, phalloplasty with pedicle ALT flap or free MSLD flap will be proposed. Urethral reconstruction will be done by a narrow free forearm flap or by a delayed thin skin graft or buccal mucosa graft. Microsurgical phalloplasty options are not limited to the forearm flap. Satisfactory results can be obtained using alternative procedure. The use of a therapeutic algorithm allows to choose the most optimal solution for each patient.
游离桡骨前臂皮瓣因功能和美学效果良好，被视为阴茎重建的金标准。供区瘢痕对于变性患者而言，可被视为其状况的特征性表现。显微外科皮瓣的发展提供了新的治疗选择。本文对这些选择进行了讨论并提出了一种治疗方案。主要使用的技术是带蒂股前外侧穿支皮瓣和游离保留肌肉的背阔肌皮瓣。列出了主要标准，其中患者的选择和局部解剖条件最为重要。前臂皮瓣仍是首选。如果该皮瓣不可行，则建议采用带蒂股前外侧皮瓣或游离保留肌肉的背阔肌皮瓣进行阴茎再造术。尿道重建将采用窄游离前臂皮瓣、延迟薄皮片移植或颊黏膜移植来完成。显微外科阴茎再造术的选择不限于前臂皮瓣。采用替代手术也可获得满意效果。使用治疗方案能够为每位患者选择最优化的解决方案。
