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Cadaver Study of Combined Neurovascular Sensate Flaps to Create Vaginal Erogenous Sensation During Male-to-Female Genital Confirmation Surgery: The Pedicle “O” Flap

Manrique, Oscar J., MD; Adabi, Kian, BA; Maldonado, Andres A., MD, PhD; Huang, Tony C., MD; Martinez-Jorge, Jorys, MD; Brassard, Pierre, MD; Galan, Ricardo, MD, MSc; Ciudad, Pedro, MD, PhD; Sabbagh, Mohamed Diya, MD

doi: 10.1097/SAP.0000000000001558
Peripheral Nerve Surgery and Research

Purpose The lack of erogenous sensitivity in the neovagina is one of the major shortcomings for patients undergoing male-to-female genital confirmation surgery. Remnant fibers of the dorsal nerve of the penis (DNP) after clitroplasty can potentially be used for a second neurovascular pedicle flap for intravaginal erogenous sensation.

Methods An anatomic dissection of the DNP was performed in 10 male frozen pelvises to identify major trunks and their branches. Lateral branches of DNP were preserved for a sensate “O” pedicle flap for the vagina. The number of main branches in the lateral dorsal aspect of the penis was calculated to ensure sufficient erogenous innervation to the vagina. Cross sections of the penis were used for histological analysis. Optimal width and length of the new sensate flap were described.

Results There were 1, 2, and 3 main branches in the lateral compartment in 2 (20%), 6 (30.7%), and 2 (42.8%) cadavers, respectively. A sensate pedicle flap from the lateral aspect of the glans penis with a mean width of 1.14 cm (range, 0.9–1.28 cm) ensured at least one main branch of the DNP for erogenous sensitivity of the vagina. This sensate vaginal flap and its neurovascular pedicle had a mean length of 9.8 cm (range, 8.7–10.3 cm) allowing its inset into the anterior vaginal canal.

Conclusion Lateral branches of the DNP can be preserved for a pedicle sensate flap to the vagina, which can provide patients with an erogenous vaginal “spot” during male-to-female confirmation surgery.

From the Mayo Clinic Minnesota, Rochester, MN.

Received April 2, 2018, and accepted for publication, after revision May 11, 2018.

O.J.M. and K.A. contributed equally to this work.

Conflicts of interest and sources of funding: none declared.

Reprints: Oscar J. Manrique, MD, Division of Plastic and Reconstructive Surgery. Transgender Intersex Specialty Clinic, Mayo Clinic, Rochester, MN. E-mail: oscarj.manrique@gmail.com.

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