Khouri R K, Young V L, Casoli V M
Miami Hand Center, Coral Gables, Florida, USA.
J Urol. 1998 Aug;160(2):383-8.
We present 5-year followup results of patients who underwent total penile reconstruction with a prefabricated lateral arm free flap technique.
We treated 3 female-to-male transsexuals and a man with penile amputation with a 2-stage technique of total penile reconstruction. In the first stage the neourethra is constructed as a tubed skin graft incorporated in the territory of the lateral arm flap. Three to 6 months later the lateral arm flap with its well epithelialized conduit is fashioned into a penis, an inflatable prosthesis is incorporated and the construction is transferred to the pubis with vascular, urethral and nerve repairs.
In addition to the 2 surgical procedures required to construct the penis, the patients have required an average of 3 revisions. There were no complications beyond the first year postoperatively. All 4 patients are able to void in the standing position and are free of fistulas or strictures. The inflatable prosthesis allows them to achieve penetration during sexual intercourse. All reconstructed penises have recovered erogenous and tactile sensibility. Patient satisfaction with the reconstructed penis is high. All transsexuals are married and fully integrated as men.
With the prefabricated lateral arm free flap technique it is possible to achieve a fully functional penis with stable long-term results and excellent patient satisfaction. To our knowledge our series represents the first report of a technique for functional penile reconstruction with at least 5 years of followup.
我们展示了采用预制侧臂游离皮瓣技术进行全阴茎重建患者的5年随访结果。
我们采用两阶段全阴茎重建技术治疗了3名女性变男性的变性者和1名阴茎切断的男性。在第一阶段，将新尿道构建为包含在侧臂皮瓣区域内的管状皮片移植。3至6个月后，将带有充分上皮化管道的侧臂皮瓣塑形为阴茎，植入可膨胀假体，并通过血管、尿道和神经修复将构建体转移至耻骨。
除了构建阴茎所需的2次外科手术外，患者平均还需要3次修复。术后第一年之后没有并发症。所有4名患者都能够站立排尿，且无瘘管或狭窄。可膨胀假体使他们在性交时能够实现插入。所有重建阴茎都恢复了性感和触觉敏感性。患者对重建阴茎的满意度很高。所有变性者都已结婚并完全融入男性生活。
采用预制侧臂游离皮瓣技术可以实现功能完全的阴茎，长期效果稳定，患者满意度高。据我们所知，我们的系列报道是关于功能性阴茎重建技术且至少有5年随访的首次报告。
