Mountain West 2019 Abstract Supplement
PURPOSE: Phalloplasty with a double-tubed radial forearm free flap (RF) is commonly performed for masculinizing gender-affirmation surgery. Previous studies have compared complication rates among differing techniques, but risk factors for complications remain unclear. We thus undertook a case-control study evaluating patient and perioperative risk factors for complications in single-stage RF phalloplasty patients. We hypothesized that fluid management factors would affect outcomes with higher complication rates among those requiring diuretics perioperatively.
METHODS: A single-center, prospective analysis of patients undergoing single-stage double-tubed RF phalloplasty with full-length urethroplasty was performed from October 2017 to December 2018. Univariate analysis was performed using input variables including age, body mass index, prior childbirth, primary glansplasty, primary scrotoplasty, number of venous microanastomoses, American Society of Anesthesiologists (ASA) score, operating time, intraoperative fluid volume, and postoperative furosemide treatment. Output variables included flap-related complications, urethral complications, and scroto/perineal complications.
RESULTS: Forty-six consecutive patients underwent RF phalloplasty reconstruction over 14 months. Intraoperative fluids ranged from 1 to 4.1 liters. Fifteen patients (32.6%) received furosemide due to flap edema; two (4.3%) additionally required flap decompression. There were no incidences of partial or total flap loss. Overall complication rate was 50%. Furosemide in the acute perioperative period was associated with a decreased risk of urethral complications (OR =0.14, p = 0.03).
CONCLUSIONS: Contrary to our hypothesis, use of perioperative furosemide was associated with fewer phalloplasty urethral complications, possibly by accelerating fluid mobilization and decreasing flap edema. Further study is necessary to confirm this mechanism and determine whether diuretics should be routinely administered perioperatively.