A new protocol for complete phalloplasty with free sensate and prelaminated osteofasciocutaneous flaps: Experience in 37 patients

Background: Herein, we present our latest protocol of following three operative stages for complete phalloplasty, applied in 37 female‐to‐male transsexuals: first, mastectomy, ovariohysterectomy, urethral lengthening, vaginectomy, colpocleisis, and neourethra prelamination; second, neophallus creation with free sensate osteofasciocutaneous fibula (n = 31) or radial forearm (n = 6) flap; and third, urethral connection, neoscrotum formation, and testicle prosthesis implantation. Results: Occasionally, wound healing disturbance and slight asymmetry of the breasts was observed, as well as colpocleisis revision needed. Partial flap necrosis took place in 6 patients, while 12 presented urethral stricture and 6 a fistula. Despite inferior neophallus sensibility, patients whose neophallus was created using fibula flap experienced better sexual intercourse. However, overall patients' satisfaction was superior. Conclusions: The applied protocol demonstrates the effectiveness of such a multistage and interdisciplinary approach for female‐to‐male transsexuals, offering an essential improvement of their quality of life, concerning their successful integration into the reassigned gender position in the society. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.