101 TOTAL PHALLOPLASTY USING MUSCULOCUTANEOUS LATISSIMUS DORSI FLAP - EXPERIENCE IN 92 PATIENTS
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You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 2011101 TOTAL PHALLOPLASTY USING MUSCULOCUTANEOUS LATISSIMUS DORSI FLAP - EXPERIENCE IN 92 PATIENTS Rados Djinovic, Sasa Tomovic, Salvatore Sansalone, Marko Milosavljevic, Vladislav Pesic, Nikola Stanojevic, and Miodrag Lazic Rados DjinovicRados Djinovic Belgrade, Yugoslavia More articles by this author , Sasa TomovicSasa Tomovic Belgrade, Yugoslavia More articles by this author , Salvatore SansaloneSalvatore Sansalone Rome, Italy More articles by this author , Marko MilosavljevicMarko Milosavljevic Belgrade, Yugoslavia More articles by this author , Vladislav PesicVladislav Pesic Belgrade, Yugoslavia More articles by this author , Nikola StanojevicNikola Stanojevic Belgrade, Yugoslavia More articles by this author , and Miodrag LazicMiodrag Lazic Belgrade, Yugoslavia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.166AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present total phalloplasty in children and adults using latissimus dorsi free flap for creation of large neophallus that allow easy performance of urethroplasty and prosthesis implantation. METHODS In the period from April 1999 to January 2010 total phalloplasty is performed in 92 patients aged between 10 and 46 yr (mean 34 yr). Indications were: congenital anomalies (9), iatrogenic injury (7) or accidental (6) trauma and transsexualism (71 patients). The flap is harvested on subscapular artery, vein and thoracodorsal nerve. Neophallus is created on site, transferred to the pubic region and anastomozed with femoral artery, saphenous vein and ilioinguinal nerve. Two-stage urethroplasty is performed in 77 patients using only buccal mucosa alone (12) or combined with split thickness skin graft (65). Donor site was closed directly in 23 patients, while in the remaining 4 split thickness skin graft was used. Inflatable prsthesis was implanted in 31 and semi-rigid in 43 pts. RESULTS Follow-up was 9 months to 11 years. Penile size varied from 13 to 19 cm in length and from 12 to 15 cm in circumference. Total flap necrosis occurred in 2 and partial in 3 patients. The donor site healed good in 34 pts, acceptably in 53, while in the remaining 12 mild to moderate moderate scarring occured. Two urethral dehiscences, 11 uretrocutaneous fistulas and 13 urethral stenosis developed that were successfully treated surgically. Function of implanted penile prostheses is satisfactory. CONCLUSIONS Musculocutaneous latissimus dorsi flap provides excellent neophallus size, good aesthetic appearance, easy implantation of penile prosthesis and urethroplasty. It can be also used successfully in pediatric population. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e43 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rados Djinovic Belgrade, Yugoslavia More articles by this author Sasa Tomovic Belgrade, Yugoslavia More articles by this author Salvatore Sansalone Rome, Italy More articles by this author Marko Milosavljevic Belgrade, Yugoslavia More articles by this author Vladislav Pesic Belgrade, Yugoslavia More articles by this author Nikola Stanojevic Belgrade, Yugoslavia More articles by this author Miodrag Lazic Belgrade, Yugoslavia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...Keywords:
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INTRODUCTION AND OBJECTIVE: Metoidioplasty can be a definitive reconstruction option in transmen, but can also be an intermediate step towards phalloplasty. During the metoidioplasty, the vagina is excised (in most cases), scrotum and perineal are reconstructed, and the urethra is lengthened. As these steps have already been performed in case of prior metoidioplasty, staged phalloplasty might be associated with less urethral and flap-related complications compared to immediate (all-in-one) phalloplasty. This hypothesis was evaluated in this retrospective study. METHODS: Between 2006 and 2019, 27 patients underwent phalloplasty after prior metoidioplasty (staged phalloplasty). These patients were matched for type of flap and time period with a cohort of 27 patients who underwent immediate phalloplasty (group 2). Phalloplasty was performed with a radial forearm free flap and pedicled anterolateral thigh flap in 36 and 18 patients respectively. There were no significant differences for age, body mass index and smoking habits between both groups. Vaginectomy was performed in 23 (85%) and 20 patients (74%) in the staged and immediate phalloplasty group, respectively (p=0.31). In case of staged phalloplasty, the phalloplasty was performed after a median of 11 months (range: 4-42) after metoidioplasty. RESULTS: Median follow-up after phalloplasty was respectively 32 and 33 months for staged and immediate phalloplasty (p=0.99).For staged phalloplasty, metoidioplasty required a median operation time of 125 minutes, a median hospital stay of 5 days (range: 3-12) and a median catheter stay of 16 days. Respectively 1 (3.7%) and 2 patients (7.4%) required subsequent surgery because of respectively a perineal fistula and stricture before phalloplasty.For staged and immediate phalloplasty, median operation time was 396 and 410 minutes (p=0.6), median hospital stay was 16 and 17 days (p=0.5) with a median catheter stay of 19 and 20 days (p=0.9), respectively. In both groups, 16 patients (59%) needed at least one additional surgical procedure for postoperative complications, urethral complications (stricture, fistula) and/or flap-related complications (partial/total flap necrosis). For staged phalloplasty, additional surgery was needed because of urethral complications only, flap-related complications only, both urethral and flap-related complications, postoperative hematoma and combined urethral complications with postoperative hematoma in respectively 4 (15%), 1(3.7%), 8 (30%), 2 (7.4%) and 1 patients (3.7%), whereas this was respectively the case in 5 (19%), 3 (11%), 6 (22%), 2 (7.4%) and 0 patients who underwent immediate phalloplasty (p=0.9). CONCLUSIONS: Postoperative complications are not reduced in case metoidioplasty has been performed prior to phalloplasty. In case metoidioplasty is considered as a step towards phalloplasty, the separate morbidity of metoidioplasty must be taken into account. Source of Funding: none
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