Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals

Summary Gender reassignment operations in female-to-male transsexuals are increasing in number as the skill of phalloplasty develops. The authors are performing phalloplasty 1 year after undergoing mastectomy, reduction of nipples, oophrectomy and hysterectomy in female-to-male transsexuals. The ideal penile reconstruction should be a single-stage procedure, creating a phallus with both tactile and erogenous sensibility, water-tight neourethra allowing for voiding in the standing position, enough bulk with stiffness, and an aesthetically acceptable appearance. We performed phalloplasty with radial forearm osteocutaneous free flaps on 40 female-to-male transsexual patients from March 1991 to December 2005. We investigated the results with regard to aesthetic and functional status and complications through physical examinations and interviews over a period of 14 years. The results are as follows: 1. Fistula on the neourethra is the most frequent and troublesome complication. 2. The autogenous bone or cartilage seems to be a reliable stiffener in the construction of the phallus. 3. Erogenous sensibility of the constructed phallus was relatively good. 4. The benefits of phalloplasty with radial forearm free flaps include the fact that it is a single stage procedure, acceptable aesthetic appearance, enough bulk and length, good sensation and the feasibility of inserting a stiffener in the penile shaft. In conclusion, we have been able to construct a good phallus with radial forearm osteocutaneous free flaps that is aesthetically and functionally acceptable. In addition, complications have been minimal.