Division of Plastic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Urol. 2018 Jan;199(1):206-214. doi: 10.1016/j.juro.2017.07.084. Epub 2017 Jul 29.
Phalloplasty is a critical step in female-to-male (transmale) gender confirming genital surgery. We examined outcomes between transmales who underwent phalloplasty with vaginectomy and full-length urethroplasty using the anterolateral thigh pedicled flap or the radial forearm free flap.
We performed a single center, retrospective study of patients who underwent phalloplasty with vaginectomy and full-length urethroplasty using an anterolateral thigh pedicled flap or a radial forearm free flap from April 2013 to July 2016. All patients had at least 6 months of followup. Urethral and nonurethral complications were recorded. Complication rates were assessed using the OR of the anterolateral thigh pedicled flap and the radial forearm free flap groups.
Of the 213 patients 149 and 64 underwent radial forearm free flap and anterolateral thigh pedicled flap phalloplasty, respectively. Patients with a radial forearm free flap had a significantly higher body mass index than those with an anterolateral thigh pedicled flap. The overall urethral complication rate for radial forearm free flap and anterolateral thigh pedicled flap phalloplasty was 31.5% and 32.8%, and the rate of partial or total neophallus loss was 3.4% and 7.8%, respectively. Patients in the pedicled flap cohort experienced significantly greater odds of urethral fistula (OR 2.50, p = 0.024), nonurethral complications (OR 2.38, p = 0.027) and phallus wound dehiscence (OR 5.03, p = 0.026).
Anterolateral thigh pedicled flap phalloplasty was associated with overall greater odds of urethral and other complications at 6 months of followup. Our findings can help guide surgical decision making when selecting a flap for phalloplasty.
阴茎成形术是女性到男性（变性男性）性别确认生殖器手术的关键步骤。我们检查了接受阴蒂切除术和全长尿道成形术的变性男性，他们使用股前外侧皮瓣或游离桡侧前臂皮瓣的结果。
我们对 2013 年 4 月至 2016 年 7 月期间接受阴蒂切除术和全长尿道成形术的患者进行了单中心回顾性研究，他们使用股前外侧皮瓣或游离桡侧前臂皮瓣进行了阴茎成形术。所有患者均有至少 6 个月的随访。记录尿道和非尿道并发症。使用股前外侧皮瓣和游离桡侧前臂皮瓣组的 OR 评估并发症发生率。
在 213 例患者中，149 例和 64 例行游离桡侧前臂皮瓣和股前外侧皮瓣阴茎成形术。游离桡侧前臂皮瓣组患者的体重指数明显高于股前外侧皮瓣组。游离桡侧前臂皮瓣和股前外侧皮瓣阴茎成形术的总尿道并发症发生率分别为 31.5%和 32.8%，部分或全部新阴茎丢失的发生率分别为 3.4%和 7.8%。皮瓣组患者的尿道瘘（OR 2.50，p = 0.024）、非尿道并发症（OR 2.38，p = 0.027）和阴茎伤口裂开（OR 5.03，p = 0.026）的可能性显著更高。
股前外侧皮瓣阴茎成形术与 6 个月随访时的尿道和其他并发症总体发生率较高相关。我们的发现可以帮助指导在选择阴茎成形术皮瓣时进行手术决策。
