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Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?

Monstrey, Stan M.D., Ph.D.; Hoebeke, Piet M.D., Ph.D.; Selvaggi, Gennaro M.D.; Ceulemans, Peter M.D.; Van Landuyt, Koen M.D., Ph.D.; Blondeel, Phillip M.D., Ph.D.; Hamdi, Moustapha M.D., Ph.D.; Roche, Nathalie M.D.; Weyers, Steven M.D.; De Cuypere, Griet M.D.

Plastic and Reconstructive Surgery: August 2009 - Volume 124 - Issue 2 - p 510-518
doi: 10.1097/PRS.0b013e3181aeeb06

Background: The ideal goals in penile reconstruction are well described, but the multitude of flaps used for phalloplasty only demonstrates that none of these techniques is considered ideal. Still, the radial forearm flap is the most frequently used flap and universally considered as the standard technique.

Methods: In this article, the authors describe the largest series to date of 287 radial forearm phalloplasties performed by the same surgical team. Many different outcome parameters have been described separately in previously published articles, but the main purpose of this review is to critically evaluate to what degree this supposed standard technique has been able to meet the ideal goals in penile reconstruction.

Results: Outcome parameters such as number of procedures, complications, aesthetic outcome, tactile and erogenous sensation, voiding, donor-site morbidity, scrotoplasty, and sexual intercourse are assessed.

Conclusions: In the absence of prospective randomized studies, it is not possible to prove whether the radial forearm flap truly is the standard technique in penile reconstruction. However, this large study demonstrates that the radial forearm phalloplasty is a very reliable technique for the creation, mostly in two stages, of a normal-appearing penis and scrotum, always allowing the patient to void while standing and in most cases also to experience sexual satisfaction. The relative disadvantages of this technique are the rather high number of initial fistulas, the residual scar on the forearm, and the potential long-term urologic complications. Despite the lack of actual data to support this statement, the authors feel strongly that a multidisciplinary approach with close cooperation between the reconstructive/plastic surgeon and the urologist is an absolute requisite for obtaining the best possible results.

Ghent, Belgium

From the Department of Plastic Surgery, the Department of Urology, the Department of Gynaecology, and the Department of Psychiatry and Gender Issues, Ghent University Hospital.

Received for publication October 3, 2008; accepted February 9, 2009.

Disclosure: None of the authors received any funds or has any financial interests to disclose.

Stan Monstrey, M.D., Ph.D., Department of Plastic Surgery, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium,

©2009American Society of Plastic Surgeons