Radial forearm phalloplasty: a review of 81 cases

Since its original description more than 25 years ago, the radial forearm flap is universally considered as the golden standard for phallic reconstruction in female-to-male (FTM) transsexuals. Despite a supposedly worldwide use by many major gender teams, there is a relative paucity in the literature of large series of radial forearm phalloplasties. Moreover, although considered as an easy and reliable flap, the radial forearm has been reported to present more problems in penile reconstruction than when used in other areas (e.g. head and neck). In most publications, the reported complication rates are excessively high, and have discouraged surgeons as well as patients to continue with this kind of surgery. This article presents a review of 81 consecutive radial forearm phalloplasty procedures, performed by the same surgical team between 1992 and 2000. A detailed description is given of the immediate postoperative results, in addition to the findings on long-term follow-up. We specifically report on our experience and our current approach with: the operative sequence, preparation and position of the patient, choice and design of the flap, reconstruction of the fixed part of the urethra and vaginectomy, the recipient vessels and nerves, recommendations for re-exploration, handling of urinary tract complications, reconstruction of the scrotum, implantation of the penile stiffener and later follow-up. Special emphasis is put on the different refinements in technique, which have been made over this 8-year period to improve phalloplasty results both functionally and cosmetically.