Neophalloplasty in female-to-male transsexuals with the island tensor fasciae latae flap

In the past 60 years, several different procedures have attempted to achiev e a postoperative neophallus that is as aesthetic and as functional as poss ible after penile amputation or sex reassignment. Recently, with improvemen ts in free tissue transfer and microvascular technique, many free flap proc edures have been developed with the goal of an aesthetically acceptable neo phallus of adequate bulk that enables urination in a standing position and sexual intercourse, with minimal functional and aesthetic donor-site defect s. Most authors currently agree that the method of choice for penile reconstru ction is microsurgical free tissue transfer, although it does not always fu lfill all of the aforementioned goals in a predictable manner. In fact, com plete urethroplasty, penile rigidity, and donor-site disfigurement remain c hallenges, thus making this operation one of the most difficult in plastic surgery. The vascular anatomy of the lateral circumflex femoral artery, which we stu died in 1991 with the anatomic dissection of 27 cadavers, gave us the idea to use along tensor fasciae latae neurovascular island flap as a donor sour ce for neophalloplasty. Grounds for the procedure and its surgical planning have been carefully evaluated with 10 additional fresh cadaver dissections . Since 1991, we have performed five neophalloplasties using this procedure ; all patients were female-to-male transsexuals. In four cases, the healing was uneventful; in one case, there was a marginal necrosis of the flap bec ause of poor venous drainage, probably from a twisting of the pedicle. The island tensor fasciae latae provides a safe and sensate flap for phallo plastic procedure and leaves a less conspicuous donor scar.