ONE-STAGE TOTAL PENILE RECONSTRUCTION WITH A FREE SENSATE OSTEOCUTANEOUS FIBULA FLAP

This is the first series of total penile reconstructions with the free sensate osteocutaneous fibula flap. The main advantages of this flap lie in its intrinsic rigidity, its superior donor-site location, and i ts long vascular pedicle. The fibula flap provides better bone volume than does the radial forearm flap, which commonly results in a floppy phallus in the absence of bone. Penile prostheses in other flaps have enjoyed limited success. Forearm donor-site complications can be avoid ed. The donor site in the lower extremity can be readily covered with a sock. The vascular pedicle of the fibula flap is of sufficient lengt h to allow end-to-side anastomosis of the flap to the femoral artery. Interpositional vein grafts are unnecessary, and dissection of the inf erior epigastric artery system to serve as a donor artery may be avoid ed. The appearance of the neophallus is excellent. We present only the first four continuous cases of the six we have performed because suff icient follow-up data are available only for these four. The advantage s and disadvantages of fibula and forearm donor sites, the long-term f ate of the bony component, the importance of sensation, and the vascul arized urethral reconstruction are discussed. High patient satisfactio n and the advantages of the technique convince us that the fibula oste ocutaneous flap is superior for total penile reconstruction.