Department of Plastic and Reconstructive Surgery, Gent University Hospital, Gent, Belgium.
Department of Plastic and Reconstructive Surgery, Kaiser Permanente, San Francisco, CA.
J Sex Med. 2018 Jun;15(6):920-923. doi: 10.1016/j.jsxm.2018.01.024. Epub 2018 Mar 2.
The coronaplasty is an important step of the phalloplasty procedure as it creates a prominent coronal ridge and a constricted coronal sulcus, resulting in the transformation of a regular skin flap into a flap resembling a circumcised penis.
The aim of this article is to describe our new coronaplasty technique that exploits opposing contracting forces of 2 different skin grafts to hold the shape of a thick, distally based skin flap, resulting in a natural looking neo-phallus.
A distally based flap is raised at the junction of the middle and distal thirds of the neo-phallus. The dissection continues until adequate mobilization is obtained, so the flap can stand almost perpendicular to the axis of the shaft. 2 separate full-thickness skin grafts are harvested and placed: the first at the raw undersurface of the flap, the second at the flap's donor site. To make the sulcus deeper and to define the ridge, the lower part of the graft placed on the undersurface of the distal flap is sutured with tacking sutures. Depending on the type of flap used this procedure can be done during the phalloplasty procedure itself (axial flaps) or at least 1 week later (perforator flaps).
The new technique that we developed shows a more distinct coronal sulcus and coronal ridge, long-lasting results, and a more aesthetically pleasing and natural-appearing glans penis.
The harvested distal flap is progressively thicker and not folded, resulting in a more naturally looking ridge. The donor site is deeper than other techniques, creating a well-defined sulcus. By using 2 skin grafts the opposing force vectors increase the projection of the ridge and the deepness of the sulcus.
This technique results in a more prominent glans penis and is an important step in creating an almost naturally looking neo-phallus.
This procedure can be applied to all different kind of flaps used for phalloplasty, both in an immediate or delayed fashion. As grafts are used, partial or complete graft lost can appear. Furthermore, attention must be paid not to incise the distal flap too deep so vascularity to the distal part of the flap will not be impaired. A continuous search to optimize the aesthetic outcome of the phalloplasty procedure is necessary and with this new coronaplasty technique we hope to raise attention and take another step toward creating "the real thing." Sommeling CE, De Wolf EJ, Salim A, et al. A New Technique for Coronaplasty in Penile Reconstruction. J Sex Med 2018;15:920-923.
冠状切开术是阴茎成形术的重要步骤，因为它可以形成明显的冠状嵴和狭窄的冠状沟，从而将规则的皮瓣转变为类似于割礼后的阴茎皮瓣。
本文旨在描述我们新的冠状切开术技术，该技术利用 2 个不同皮瓣的反向收缩力来维持厚的、远端为蒂的皮瓣的形状，从而形成自然外观的新阴茎。
在新阴茎的中远端三分之一交界处掀起远端为蒂的皮瓣。继续进行解剖，直到获得足够的活动度，使皮瓣几乎垂直于轴。切取 2 个全厚皮片并放置：第一个置于皮瓣的原始底面，第二个置于皮瓣供区。为了使沟更深并定义嵴，将置于远端皮瓣底面的下部移植物用缝合钉缝合。根据使用的皮瓣类型，此过程可以在阴茎成形术过程中进行（轴型皮瓣），或者至少在 1 周后进行（穿支皮瓣）。
我们开发的新技术显示出更明显的冠状沟和嵴、持久的效果以及更美观和自然的龟头外观。
切取的远端皮瓣逐渐增厚且不折叠，形成更自然的嵴。供区比其他技术更深，形成明显的沟。通过使用 2 个皮瓣，反向力矢量增加了嵴的突出度和沟的深度。
该技术可使龟头更加突出，是创建几乎自然外观的新阴茎的重要步骤。
该技术可应用于所有用于阴茎成形术的不同类型的皮瓣，无论是即刻还是延迟应用。由于使用了移植物，可能会出现部分或完全移植物丢失。此外，必须注意不要将远端皮瓣切得太深，以免影响皮瓣远端的血供。不断优化阴茎成形术的美学效果是必要的，我们希望通过这种新的冠状切开术技术引起关注，并朝着创建“真实阴茎”的方向迈出一步。
