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New Technique of Total Phalloplasty With Reinnervated Latissimus Dorsi Myocutaneous Free Flap in Female-to-Male Transsexuals

Vesely, Jiri MD, CSc*; Hyza, Petr MD*; Ranno, Raul MD*; Cigna, Emanuele MD*; Monni, Nicola MD*; Stupka, Igor MD*; Justan, Ivan MD*; Dvorak, Zdenek MD*; Novak, Pavel MD*; Ranno, Salvatore MD, PhD

doi: 10.1097/01.sap.0000245123.16757.15
Original Article

From December 2001 to September 2005, the technique of total penile reconstruction with a reinnervated free latissimus dorsi myocutaneous flap was used in 22 patients (24–38 years old) with gender dysphoria. These patients were followed up for at least 11 months (range, 11–44 months). All flaps survived. Complications include hematoma (7 cases), vascular thrombosis (2 cases), partial necrosis (1 case), excessive swelling of the neophallus (3 cases), and skin graft loss at the donor site (1 case). Of the 19 patients included in the final evaluation, the transplanted muscle was able to obtain contraction in 18 (95%) cases and 8 patients (42%) had sexual intercourse by contracting the muscle to stiffen and move the neopenis. The described technique of neophalloplasty proved to be a reliable technique and the muscle movement in the neophallus can be expected in almost all cases. The muscle contraction in the neophallus leads to “paradox” erection—stiffening, widening, and shortening of the neopenis, which allows for sexual intercourse in some patients. Subsequent reconstruction of the urethra is possible.

Twenty-two gender dysphoria patients underwent total penile reconstruction with re-innervated free latissimus dorsi musculocutaneous flaps. Eight of the patients were able to achieve sufficient neophallic stiffening by muscle contraction to achieve intercourse.

From the *Clinic of Plastic and Aesthetic Surgery, St. Anna University Hospital, Masaryk University in Brno, Brno, Czech Republic; and the †Department of Urology, University of Catania, Catania, Italy.

Received July 8, 2006 and accepted for publication August 19, 2006.

Reprints: Jiri Vesely, MD, PhD, Klinika Plasticke a Esteticke Chirurgie, Berkova 34, 612 00–Brno, Czech Republic. E-mail: jiri.vesely@fnusa.cz.

© 2007 Lippincott Williams & Wilkins, Inc.