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Urethral reconstruction in anterolateral thigh flap phalloplasty : a 93-case experience

Salvatore D'Arpa (UGent) , Karel Claes (UGent) , Nicolaas Lumen (UGent) , Sebastiano Oieni, Piet Hoebeke (UGent) and Stan Monstrey (UGent)
(2019) PLASTIC AND RECONSTRUCTIVE SURGERY. 143(2). p.382e-392e
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Organization
Abstract
Background: Urethral reconstruction in anterolateral thigh flap phalloplasty cannot always be accomplished with one flap, and the ideal technique has not been established yet. In this article, the authors' experience with urethral reconstruction in 93 anterolateral thigh flap phalloplasties is reported. Methods: Ninety-three anterolateral thigh phalloplasties performed over 13 years at a single center were retrospectively reviewed to evaluate outcomes of the different urethral reconstruction techniques used: anterolateral thigh alone without urethral reconstruction (n = 7), tube-in-tube anterolateral thigh flap (n = 5), prelaminated anterolateral thigh flap with a skin graft (n = 8), anterolateral thigh flap combined with a free radial forearm flap (n = 29), anterolateral thigh flap combined with a pedicled superficial circumflex iliac artery perforator flap (n = 38), and anterolateral thigh flap combined with a skin flap from a previous phalloplasty (n = 6). Seventy-nine phalloplasties were performed for female-to-male sex reassignment surgery. The others were performed in male patients with severe penile insufficiency. Results: Urethral complication rates (fistulas and strictures) were as follows: tube-in-tube anterolateral thigh flap, 20 percent; prelaminated anterolateral thigh flap, 87.5 percent; free radial forearm flap urethra, 37.9 percent; superficial circumflex iliac artery perforator urethral reconstruction, 26.3 percent; and skin flap from previous phalloplasty, 16.7 percent. Conclusions: When tube-in-tube urethra reconstruction is not possible (94.2 percent of cases), a skin flap such as the superficial circumflex iliac artery perforator flap or the radial forearm flap is used for urethral reconstruction in anterolateral thigh phalloplasties. Flap prelamination is a second choice that gives high stricture rates. If a penis is present, its skin should be used for urethral reconstruction and covered with an anterolateral thigh flap. With these techniques, 91.86 percent of patients are eventually able to void while standing.
Keywords
RADIAL FOREARM FLAP, PENILE RECONSTRUCTION, PERFORATOR FLAP, SURGERY

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MLA
D’Arpa, Salvatore et al. “Urethral Reconstruction in Anterolateral Thigh Flap Phalloplasty : a 93-case Experience.” PLASTIC AND RECONSTRUCTIVE SURGERY 143.2 (2019): 382e–392e. Print.
APA
D’Arpa, S., Claes, K., Lumen, N., Oieni, S., Hoebeke, P., & Monstrey, S. (2019). Urethral reconstruction in anterolateral thigh flap phalloplasty : a 93-case experience. PLASTIC AND RECONSTRUCTIVE SURGERY, 143(2), 382e–392e.
Chicago author-date
D’Arpa, Salvatore, Karel Claes, Nicolaas Lumen, Sebastiano Oieni, Piet Hoebeke, and Stan Monstrey. 2019. “Urethral Reconstruction in Anterolateral Thigh Flap Phalloplasty : a 93-case Experience.” Plastic and Reconstructive Surgery 143 (2): 382e–392e.
Chicago author-date (all authors)
D’Arpa, Salvatore, Karel Claes, Nicolaas Lumen, Sebastiano Oieni, Piet Hoebeke, and Stan Monstrey. 2019. “Urethral Reconstruction in Anterolateral Thigh Flap Phalloplasty : a 93-case Experience.” Plastic and Reconstructive Surgery 143 (2): 382e–392e.
Vancouver
1.
D’Arpa S, Claes K, Lumen N, Oieni S, Hoebeke P, Monstrey S. Urethral reconstruction in anterolateral thigh flap phalloplasty : a 93-case experience. PLASTIC AND RECONSTRUCTIVE SURGERY. 2019;143(2):382e–392e.
IEEE
[1]
S. D’Arpa, K. Claes, N. Lumen, S. Oieni, P. Hoebeke, and S. Monstrey, “Urethral reconstruction in anterolateral thigh flap phalloplasty : a 93-case experience,” PLASTIC AND RECONSTRUCTIVE SURGERY, vol. 143, no. 2, pp. 382e-392e, 2019.
@article{8610583,
  abstract     = {Background: Urethral reconstruction in anterolateral thigh flap phalloplasty cannot always be accomplished with one flap, and the ideal technique has not been established yet. In this article, the authors' experience with urethral reconstruction in 93 anterolateral thigh flap phalloplasties is reported.
Methods: Ninety-three anterolateral thigh phalloplasties performed over 13 years at a single center were retrospectively reviewed to evaluate outcomes of the different urethral reconstruction techniques used: anterolateral thigh alone without urethral reconstruction (n = 7), tube-in-tube anterolateral thigh flap (n = 5), prelaminated anterolateral thigh flap with a skin graft (n = 8), anterolateral thigh flap combined with a free radial forearm flap (n = 29), anterolateral thigh flap combined with a pedicled superficial circumflex iliac artery perforator flap (n = 38), and anterolateral thigh flap combined with a skin flap from a previous phalloplasty (n = 6). Seventy-nine phalloplasties were performed for female-to-male sex reassignment surgery. The others were performed in male patients with severe penile insufficiency.
Results: Urethral complication rates (fistulas and strictures) were as follows: tube-in-tube anterolateral thigh flap, 20 percent; prelaminated anterolateral thigh flap, 87.5 percent; free radial forearm flap urethra, 37.9 percent; superficial circumflex iliac artery perforator urethral reconstruction, 26.3 percent; and skin flap from previous phalloplasty, 16.7 percent.
Conclusions: When tube-in-tube urethra reconstruction is not possible (94.2 percent of cases), a skin flap such as the superficial circumflex iliac artery perforator flap or the radial forearm flap is used for urethral reconstruction in anterolateral thigh phalloplasties. Flap prelamination is a second choice that gives high stricture rates. If a penis is present, its skin should be used for urethral reconstruction and covered with an anterolateral thigh flap. With these techniques, 91.86 percent of patients are eventually able to void while standing.},
  author       = {D'Arpa, Salvatore and Claes, Karel and Lumen, Nicolaas and Oieni, Sebastiano and Hoebeke, Piet and Monstrey, Stan},
  issn         = {0032-1052},
  journal      = {PLASTIC AND RECONSTRUCTIVE SURGERY},
  keywords     = {RADIAL FOREARM FLAP,PENILE RECONSTRUCTION,PERFORATOR FLAP,SURGERY},
  language     = {eng},
  number       = {2},
  pages        = {382e--392e},
  title        = {Urethral reconstruction in anterolateral thigh flap phalloplasty : a 93-case experience},
  url          = {http://dx.doi.org/10.1097/prs.0000000000005278},
  volume       = {143},
  year         = {2019},
}

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