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Long-Term Fate of the Bony Component in Neophallus Construction with Free Osteofasciocutaneous Forearm or Fibula Flap in 18 Female-to-Male Transsexuals

Papadopulos, Nikolaos A. M.D.; Schaff, Juergen M.D.; Biemer, Edgar M.D., Ph.D.

Plastic and Reconstructive Surgery: March 2002 - Volume 109 - Issue 3 - p 1025–1030
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Female-to-male transsexuals have been operated on in the authors' department since 1975. Between 1981 and 1995, 46 patients underwent neophallus construction with a free osteofasciocutaneous forearm or fibula flap. The bony part of these flaps is embedded in tissue with excellent blood circulation, has no contact with the skeleton, and is free of mechanical stress. To evaluate the long-term fate of the bony component of these flaps, the authors examined 18 of the 46 patients (39.1 percent) who had received a neophallus by means of one of these methods (12 with forearm and six with fibula flap) and who were willing to participate in the updating of the results of the previous two decades; this represented a follow-up of 5 to 112 months postoperatively (average, 27.4 months). The following investigations were undertaken: clinical and radiologic examination, bone scintigraphy, magnetic resonance imaging, and histologic examination of the neophallus bony component. In all patients, the clinical examination showed no significant variations in the shape and rigidity of the neophallus bone. The radiologic examination showed a compact bone structure, and the magnetic resonance imaging proved the vitality of the neophallus in all patients, with no significant changes over time. Bone scintigraphy did not prove to be useful in determining the long-term fate of the neophallic bony component. Histologically, subperiosteal neoformation of fibrous bone was shown, whereas the lamellar cortical bone was predominantly avital. The results of this study reveal the vitality of the bony component in neophallus construction with free osteofasciocutaneous flaps. Even 112 months after the procedure, it provided sufficient stiffness for sexual intercourse. This continuing adequate rigidity of the bony component, in addition to the wellknown advantages of the free osteofasciocutaneous flap, is further evidence of its usefulness in neophallus construction. (Plast. Reconstr. Surg. 109: 1025, 2002.)

Munich and Dachau, Germany

Nikolaos A. Papadopulos, M.D. Department of Plastic and Reconstructive Surgery Klinikum rechts der Isar Technical University Munich Ismaningerstr. 22 D-81675 Munich Germany

From the Department of Plastic and Reconstructive Surgery, Technical University Munich, and the Department of Hand, Micro-, and Plastic Surgery, Kreiskliniken Dachau-Indersdorf. Received for publication December 5, 2000; revised May 14, 2001.

Presented in part at the 12th Congress of the International Confederation of Societies for Plastic, Reconstructive, and Aesthetic Surgery, San Francisco, California, June 27 through July 2, 1999.

©2002American Society of Plastic Surgeons