Benson Travis A, Boskey Elizabeth R, Ganor Oren
Harvard Medical School, Boston, Massachusetts.
Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts.
MDM Policy Pract. 2020 Jun 29;5(1):2381468320938740. doi: 10.1177/2381468320938740. eCollection 2020 Jan-Jun.
The radial forearm free flap (RFFF) is considered the gold standard for gender affirming phalloplasty. Ideally, a nondominant forearm flap is used to minimize the risk of functional morbidity. However, many transmasculine individuals have tattooed forearms, which can affect decision making. The purpose of this study was to understand the prevalence of forearm tattoos among transmasculine patients seeking phalloplasty and how and whether tattoos affected decision making about flap source. Participants were 50, consecutive, adult, transmasculine patients seeking phalloplasty. The presence and location of tattoos were assessed using consult notes in the electronic medical record. A one-tailed test of proportions was used to test whether forearm tattoos increased the likelihood of alternative flap choice. More than half of patients (56%) had tattoos on either one or both forearms ( = 28), 75% on their nondominant arm ( = 21). Among the patients with forearm tattoos, the presence of tattoos affected the flap site decision for 46% of patients ( = 13). For the patients that chose an alternative flap site, 46% chose a dominant forearm RFFF ( = 6) and 54% an anterolateral thigh flap ( = 7). The percentage of patients whose records indicated that they were planning on using an alternative flap due to a tattoo on their nondominant forearm was significantly higher than the percentage of patients without such tattoos, indicating the desire for an alternate flap ( < 0.01). Many transmasculine patients seeking phalloplasty have tattoos on either one or both of their forearms. Because of this, a substantial fraction of patients may choose flap donor sites that are less ideal. Providers from all disciplines may wish to educate young transmasculine patients about how tattoo placement may affect surgical options earlier during transition.
桡侧前臂游离皮瓣（RFFF）被认为是性别肯定阴茎成形术的金标准。理想情况下，应使用非优势侧前臂皮瓣以将功能发病风险降至最低。然而，许多跨性别男性个体的前臂有纹身，这可能会影响决策。本研究的目的是了解寻求阴茎成形术的跨性别男性患者中前臂纹身的患病率，以及纹身如何以及是否影响皮瓣供区的决策。研究对象为50例连续的成年跨性别男性阴茎成形术患者。通过电子病历中的会诊记录评估纹身的存在情况和位置。使用单尾比例检验来测试前臂纹身是否增加了选择其他皮瓣的可能性。超过一半的患者（56%）一侧或双侧前臂有纹身（n = 28），75%的纹身位于非优势侧手臂（n = 21）。在前臂有纹身的患者中，纹身影响了46%患者（n = 13）的皮瓣供区决策。对于选择其他皮瓣供区的患者，46%选择了优势侧前臂RFFF（n = 6），54%选择了股前外侧皮瓣（n = 7）。记录显示因非优势侧前臂纹身而计划使用其他皮瓣的患者比例显著高于无此类纹身的患者比例，表明患者希望选择其他皮瓣（P < 0.01）。许多寻求阴茎成形术的跨性别男性患者一侧或双侧前臂有纹身。因此，相当一部分患者可能会选择不太理想的皮瓣供区。所有学科的医疗服务提供者可能都希望在跨性别男性患者过渡早期就对他们进行教育，告知纹身位置如何可能影响手术选择。
