From the Division of Plastic and Reconstructive Surgery, Oregon Health and Science University.
Plast Reconstr Surg. 2020 Aug;146(2):196e-204e. doi: 10.1097/PRS.0000000000007036.
Phalloplasty often requires free tissue transfer. There is ample literature describing flap-related outcomes, but the microsurgical technique used, including choice of recipient vessels, has been an overlooked yet important topic. In this study, the authors review the outcomes of their experience with the deep inferior epigastric artery and locoregional veins and outline technical modifications that occurred during the study period.
A retrospective chart analysis of patients who underwent microsurgical phalloplasty between September of 2016 and July of 2019 was performed. Variables included flap design, donor site, and recipient vessels. The outcome measures were return to the operating room for flap compromise and partial or complete flap loss.
Forty-two phalloplasties using the deep inferior epigastric artery were identified. There were six take-backs for flap compromise, and four patients required venous revision, one of whom lost his urethral flap on postoperative day 9. There was a decrease in take-back rate from 30 percent in the first 20 patients to 0 percent in the second 22 patients in the study period. A total of 11.9 percent of patients had partial flap loss. This decreased from 15 percent to 9 percent in the two groups.
After an initial learning curve, the combination of deep inferior epigastric artery, deep inferior epigastric vein, and great saphenous vein combined with specific technical modifications such as targeted coagulation of the vasa nervorum of the clitoral nerve has proven to be a reliable technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
阴茎再造术常需进行游离组织移植。有大量文献描述了皮瓣相关的结果，但皮瓣所使用的显微外科技术，包括受区血管的选择，一直是一个被忽视但很重要的话题。在这项研究中，作者回顾了他们在使用腹壁下深动脉和局部静脉方面的经验，并概述了研究期间发生的技术修改。
对 2016 年 9 月至 2019 年 7 月期间接受显微阴茎再造术的患者进行了回顾性图表分析。变量包括皮瓣设计、供区和受区血管。主要转归指标是皮瓣失活而再次手术以及部分或完全皮瓣坏死。
共确定了 42 例采用腹壁下深动脉的阴茎再造术。有 6 例因皮瓣失活而再次手术，4 例患者需要静脉修正，其中 1 例在术后第 9 天失去了尿道皮瓣。在研究期间，首次 20 例患者中有 30%需要再次手术，而随后的 22 例患者中则无皮瓣失活。总的来说，有 11.9%的患者发生部分皮瓣坏死，其中两组的发生率分别从 15%降至 9%。
在经历了最初的学习曲线后，腹壁下深动脉、腹壁下深静脉和大隐静脉的组合，结合特定的技术修改，如靶向阻断阴茎背神经的血管神经束，已被证明是一种可靠的技术。
临床问题/证据水平：治疗，IV。
