XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Phallic Construction with Two Free Flaps

HARASHINA, TAKAO JAPAN
Co-authors: Yoshiharu Inoue & Ako Takamatsu (Japan)
E-mail: harasina@saitama-med-ac.jp

A case of phallic construction using two free flaps, a deltoid flap and an ulnar forearm flap will be presented. The patient is a 54-year-old male with congenital micropenis. An urethra was constructed with an ulnar forearm flap and a deltoid flap provided external coverage of the phallus. The recipient vessels used were bilateral deep inferior epigastric vessels harvested through lower abdominal midline incision. Ilioinguinal nerve was chosen as recipient nerve as dorsal penile nerve could not be located.

Discussion: There should be no disagreement that the first method of choice for phallic construction or reconstruction is microsurgical. The problem is which free flap should be used for this purpose. It must be a neurosensory free flap which is thin, durable, adequately large in size, as hairless as possible, have consistent and reliable vascular and neural anatomy with a long and large neurovascular pedicle, and should be capable of sensory reinnervation.

More than 90% of the constructed phallus that have bene reported so far in the world literature are constructed with radial forearm flaps. This flap meets all the criteria mentioned above but its biggest disadvantage is its donor site scar. To construct a phallus, which is rarely exposed, the price to pay is really expensive, almost entire length and circumference of the skin graft of the forearm. So our first donor site of choice is a deltoid flap whenever possible (Brit J Past Surg 43: 217, 1990).

The biggest and probably the only disadvantage of deltoid flap is its thickness. We have constructed 13 phallus using deltoid flap and among these cases only two cases did not require primary or secondary defatting or debulking procedure.