Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases

From July 1994 to December 1996, 22 cases of primary female transsexualism received phalloplasty using free radial forearm osteocutaneous flaps in The Veterans General Hospital, Taipei, Taiwan. Follow-up period ranged from 6 months to 35 months. No complete flap loss and one partial loss (10% reduction) were noted after operation. The urethrocutaneous fistula rate was 40.9%, needing fistula repair surgery. Urethral stricture was noted in three cases (13.7%). Significant donor forearm morbidity was noted in two cases (9.1%) including one who suffered from radius bone fracture. All preserved ‘clitorises’ had intact erotic sensation and all neophalli gained protective sensation within 9 months. No ‘penile fracture’ was noted. In nine cases that have regular sexual activities, the sexual performance was rated as satisfactory. We share our experience and recommend that the free radial forearm osteocutaneous tubing flap is a promising choice for phalloplasty in female-to-male transsexuals.