F. Santanelli et N. Scuderi, Neophalloplasty in female-to-male transsexuals with the island tensor fasciae latae flap, PLAS R SURG, 105(6), 2000, pp. 1990-1996
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.