Hu W, Henry A S, Rouanet M, Pop A, Claudic Y, Vais B, Perrier A, Tehri I, Saraoui W, Perruisseau-Carrier A
Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; Faculté de médecine, université de Brest, 22, rue Camille-Desmouqlins, 29238 Brest, France.
Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
Ann Chir Plast Esthet. 2023 Nov;68(5-6):446-454. doi: 10.1016/j.anplas.2023.08.003. Epub 2023 Aug 29.
The aims of this article are to provide an overview of the technique of phalloplasty by radial forearm free flap in the context of female-to-male gender reassignment surgery, with a specific focus on surgical technical details and the prevention of postoperative complications.
In the light of our 30 years of experience in caring for female-to-male transgender individuals and conducting a critical review of the literature, we exhaustively present our technique of radial forearm free flap phalloplasty in female-to-male gender reassignment surgery.
The technique of radial forearm free flap phalloplasty, utilizing a one-stage approach for neourethral and neophallus construction based on the "tube within a tube" principle, not only achieves an aesthetically pleasing appearance of the neophallus resembling a normal penis with tactile and erogenous sensitivities but also yields a functional neourethra and satisfactory penile rigidity using implants for standing voiding and sexual intercourse. This intricate surgical procedure demands not only meticulous execution of all surgical maneuvers but also high-level postoperative care. Despite refinements in technique over recent decades, aesthetic sequelae at the donor site of the flap remain subject to criticism, and postoperative complications, particularly of vascular and urological nature, remain significant.
Future optimization of the surgical technique for this procedure will be imperative to minimize postoperative complications and establish a true technical "gold standard" for phalloplasty in female-to-male transgender individuals.
本文旨在概述在女性变男性性别重置手术中，采用桡侧前臂游离皮瓣进行阴茎成形术的技术，特别关注手术技术细节及术后并发症的预防。
鉴于我们在照顾女性变男性跨性别者方面30年的经验，并对文献进行批判性综述，我们详尽介绍了在女性变男性性别重置手术中采用桡侧前臂游离皮瓣进行阴茎成形术的技术。
桡侧前臂游离皮瓣阴茎成形术采用基于“管中管”原则的一期方法构建新尿道和新阴茎，不仅使新阴茎外观美观，类似正常阴茎，具有触觉和性敏感，还能通过植入物实现站立排尿和性交功能，获得功能性新尿道和令人满意的阴茎硬度。这一复杂的手术过程不仅需要精确执行所有手术操作，还需要高水平的术后护理。尽管近几十年来技术有所改进，但皮瓣供区的美学后遗症仍受到批评，术后并发症，尤其是血管和泌尿系统并发症仍然严重。
未来必须优化该手术技术，以尽量减少术后并发症，并为女性变男性跨性别者的阴茎成形术建立真正的技术“金标准”。
