De Gelder Anouk, Young-Afat Danny, Claes Karel, Morrison Shane, Lumen Nikolaas, Spinoit Anne-Françoise, Waterschoot Mieke, D'Arpa Salvatore, Monstrey Stan, Buncamper Marlon
From the Departments of Plastic Surgery.
Department of Plastic Surgery.
Plast Reconstr Surg. 2025 Jun 1;155(6):1036e-1044e. doi: 10.1097/PRS.0000000000011830. Epub 2024 Oct 28.
Although the free radial forearm flap (FRFF) is the standard for phalloplasty, the conspicuous donor-site scar, need for microsurgery, and tendency for the phallus to deflate over time leads both patients and surgeons to seek alternatives. The authors describe their long-term experience with the pedicled superficial circumflex iliac artery (SCIP) flap for urethral or penile shaft reconstruction, or both. This flap can be applied for similar indications as FRFF phalloplasty, but with primary closure of the donor sites and without microsurgery.
The authors retrospectively reviewed surgical outcomes of all patients who underwent urethra or shaft reconstruction, or both, using SCIP flaps as part of phalloplasty for gender-affirming surgery in their center between 2012 and 2022.
Over a 10-year period, 55 SCIP flaps were performed as part of phalloplasty. This included 47 unilateral SCIP flaps, 10 of which were used for shaft reconstructions and 37 for urethra reconstructions. Primary closure was achieved in 100% of patients. No failures were observed for shaft reconstructions. For urethra reconstructions, 8 SCIP urethras (14%) failed completely, and 3 SCIP flaps were converted to free flaps. In total, 82% of patients with a SCIP urethra reconstruction were able to stand while voiding. Eight bilateral SCIP flaps were performed for 1-stage shaft and urethra creation; among these, 3 patients (38%) experienced urethral fistulas or strictures.
This study shows that the SCIP flap is a technically feasible and safe pedicled alternative for urethral and penile shaft reconstruction in gender-diverse individuals, with similar urethral complication rates compared with FRFF and anterolateral thigh flap phalloplasty, but with potentially lower shaft sensation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
尽管游离桡侧前臂皮瓣（FRFF）是阴茎再造的标准术式，但明显的供区瘢痕、显微外科手术的需求以及阴茎随时间逐渐萎缩的趋势，促使患者和外科医生都在寻找替代方案。作者描述了他们使用带蒂旋髂浅动脉（SCIP）皮瓣进行尿道或阴茎体重建或两者同时重建的长期经验。该皮瓣可用于与FRFF阴茎再造类似的适应证，但供区可一期缝合，无需显微外科手术。
作者回顾性分析了2012年至2022年期间在其中心接受性别肯定手术的患者中，所有使用SCIP皮瓣进行尿道或阴茎体重建或两者同时重建作为阴茎再造一部分的手术结果。
在10年期间，共进行了55例作为阴茎再造一部分的SCIP皮瓣手术。其中包括47例单侧SCIP皮瓣，其中10例用于阴茎体重建，37例用于尿道重建。所有患者均实现了一期缝合。阴茎体重建未观察到失败病例。对于尿道重建，8例SCIP尿道（14%）完全失败，3例SCIP皮瓣转为游离皮瓣。总体而言，82%接受SCIP尿道重建的患者能够站立排尿。8例双侧SCIP皮瓣用于一期阴茎体和尿道再造；其中3例患者（38%）出现尿道瘘或尿道狭窄。
本研究表明，SCIP皮瓣是性别多样化个体进行尿道和阴茎体重建的一种技术可行且安全的带蒂替代方案，与FRFF和股前外侧皮瓣阴茎再造相比，尿道并发症发生率相似，但阴茎体感觉可能较低。
临床问题/证据级别：治疗性，IV级。
