LONG-TERM RESULTS OF TOTAL PENILE RECONSTRUCTION WITH A PREFABRICATEDLATERAL ARM FREE-FLAP

Purpose: We present 5-year followup results of patients who underwent total penile reconstruction with a prefabricated lateral arm free flap technique. Materials and Methods: We treated 3 female-to-male transse xuals and a man with penile amputation with a 2-stage technique of tot al penile reconstruction. In the first stage the neourethra is constru cted as a tubed skin graft incorporated in the territory of the latera l arm flap. Three to 6 months later the lateral arm flap with its well epithelialized conduit is fashioned into a penis, an inflatable prost hesis is incorporated and the construction is transferred to the pubis with vascular, urethral and nerve repairs. Results: In addition to th e 2 surgical procedures required to construct the penis, the patients have required an average of 3 revisions. There were no complications b eyond the first year postoperatively. All 4 patients are able to void in the standing position and are free of fistulas or strictures. The i nflatable prosthesis allows them to achieve penetration during sexual intercourse. All reconstructed penises have recovered erogenous and ta ctile sensibility. Patient satisfaction with the reconstructed penis i s high. All transsexuals are married and fully integrated as men. Conc lusions: With the prefabricated lateral arm free flap technique it is possible to achieve a fully functional penis with stable long-term res ults and excellent patient satisfaction. To our knowledge our series r epresents the first report of a technique for functional penile recons truction with at least 5 years of followup.