Phalloplasty in children and adolescents using the extended pedicle island groin flap.

An operative procedure for phalloplasty is reported that uses an extended pedicle island groin flap. Forming a combined groin and lower abdominal flap based on the superficial iliac and epigastric vessels is the main characteristic of this technique. The flap consists of 3 parts: 1) the lateral narrow hairless part for the neourethra, 2) the medial wide part for neophallus shaft reconstruction and 3) the base of the flap on which a flap pedicle is formed and lengthened by de-epithelializing the skin. The pedicle includes subcutaneous tissue with blood and lymph vessels. The neourethra and neophallus shaft are reconstructed using a tube-within-tube technique. The size of the flap depends on patient build. The flap is transferred to the recipient area, that is to the level of the lower margin of symphysis. Anastomosis of the new and native urethra may be done simultaneously or during the second stage of the procedure. The donor site skin defect is closed by direct approximation. During 3 years (1991 to 1993) this flap technique was performed on 24 patients (age 12 to 18 years). There were 2 main indications for treatment: 1) complete absence of the penis, and so total reconstruction of the phallus was done and 2) small dimensions of the penis or just a penile stump, and so augmentation of the penis was done. Specific indications were female transsexualism in 4 patients, penile amputation in 2 and a small disabled penis in 18 (the exstrophy-epispadias complex, intersex and micropenis). Followup ranged from 6 to 42 months (average 29). A new phallus of satisfactory dimensions was achieved in all cases. Complications included partial necrosis of the flap in 2 patients, fistulas in 2 and stenosis of the urethral anastomosis in 1. These complications were successfully resolved by corrective surgery. The method is simple and timesaving with a minor complication rate. This technique is the available alternative to the most commonly used procedure, that is microsurgical free tissue phalloplasty.