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Neophalloplasty in Female-to-Male Transsexuals with the Island Tensor Fasciae Latae Flap

Santanelli, Fabio M.D., Ph.D.; Scuderi, Nicolò M.D.

Plastic and Reconstructive Surgery: May 2000 - Volume 105 - Issue 6 - p 1990-1996

In the past 60 years, several different procedures have attempted to achieve a postoperative neophallus that is as aesthetic and as functional as possible after penile amputation or sex reassignment. Recently, with improvements in free tissue transfer and microvascular technique, many free flap procedures have been developed with the goal of an aesthetically acceptable neophallus of adequate bulk that enables urination in a standing position and sexual intercourse, with minimal functional and aesthetic donor-site defects.

Most authors currently agree that the method of choice for penile reconstruction is microsurgical free tissue transfer, although it does not always fulfill all of the aforementioned goals in a predictable manner. In fact, complete urethroplasty, penile rigidity, and donor-site disfigurement remain challenges, thus making this operation one of the most difficult in plastic surgery.

The vascular anatomy of the lateral circumflex femoral artery, which we studied in 1991 with the anatomic dissection of 27 cadavers, gave us the idea to use a long tensor fasciae latae neurovascular island flap as a donor source for neophalloplasty. Grounds for the procedure and its surgical planning have been carefully evaluated with 10 additional fresh cadaver dissections. Since 1991, we have performed five neophalloplasties using this procedure; all patients were female-to-male transsexuals. In four cases, the healing was uneventful; in one case, there was a marginal necrosis of the flap because of poor venous drainage, probably from a twisting of the pedicle.

The island tensor fasciae latae provides a safe and sensate flap for phalloplastic procedure and leaves a less conspicuous donor scar. (Plast. Reconstr. Surg. 105: 1990, 2000.)

Rome, Italy

From the Department of Plastic Surgery, University of Rome “La Sapienza.”

Received for publication May 7, 1998;

revised May 7, 1999.

Fabio Santanelli, M.D., Ph.D. Via Archimede 129 00197 Rome, Italy

Presented at the 8th Annual Meeting of the European Association of Plastic Surgeons, in Amsterdam, The Netherlands, May 15 through 17, 1997, and the 1st International Interdisciplinary Symposium on Genitourinary Reconstructive Surgery in Congenital Malformations, Transsexuals, and Impotence, in Barcelona, Spain, April 6 through 8, 1998.

Dedicated to Professor Giovanni Micali, M.D., Head of the Department of Plastic and Reconstructive Surgery, University of Catania Medical School, on the occasion of his election as Italian President of UNICEF.

©2000American Society of Plastic Surgeons