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October 14-15, 2011
Poster presentations: Total phalloplasty in female transsexuals: technique and outcomes.
Anterior urethral substitution by combined buccal mucosa graft and penile skin flap.
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Phalloplasty

Phalloplasty is surgical procedure of creating a neophallus from an extra genital tissue that provides male-like and functional penis.

Major indications for phalloplasty can be divided in two groups: male patients with penile insufficiency, and female to male transgender patients. Penile insufficiency can be caused by congenital anomalies (penile agenesia, micropenis, failed epispadia and hyposapdia repair or disorders of sex development) and acquired conditions such as iatrogenic or accidental injuries.
For some of these patient phalloplasty can be performed even in pediatric age in order to prevent profound psychological problems related to body dysmorphia. In female to male gender reassignment surgery phalloplasty presents a major surgical step.

Ideal phalloplasty must gratify both cosmetic and functional requirements. Created neophallus should have aspect of normal male penis, with acceptable scarring of donor site. Voiding must be feasible in standing position. Neophallus have to be huge enough to enable inserting of penile prosthesis which can obtain satisfactory rigidity and hence provide penetration during sexual intercourse.

There are many alternatives for extragenital tissue that can be used for creation of neophallus (groin flap, forearm flap, rectus abdominis flap, fibular flap, musculocutaneous latissimus dorsi flap). The musculocutaneous latissimus dorsi flap is an acceptable choice for phalloplasty in all these groups of patients because it has a reliable and suitable vascular anatomy, large surface area, giving an excellent penile size, large enough to allow creation of the urethra and implantation of a penile prosthesis. Moreover, the penis can be constructed to the size desired by the patient. The donor site can be closed directly in most patients, with a satisfactory outcome if it is prepared appropriately by superficial skin massage using anti-scar ointment to improve skin elasticity. Hidden donor site is additonal advange in comparison to other more exposed donor sites.  The latissimus dorsi total phalloplasty can entirely meet the esthetic and functional requirements of penile reconstruction.

In order to improve the outcome and make this operation as safe and short as possible we have enrolled the whole team of surgeons. The team comprises of two urologists, two anesthesiologists, two gynecologists, two plastic surgeons and one vascular surgeon. Duration of total phallolasty procedure is now reduced to 7 hours. During phalloplasty the whole team takes part in operating on the patient, making sure that the surgery would be a successful one.
 

Case 1 Total phalloplasty
(click image for larger view)

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Design of the latissimus dorsi muscle flap.
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Flap harvesting.
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Tubularization of the flap.
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Donor site closure. Direct approximation with split ticknes skin graft.
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Appearance after surgery.

Case 2 Total phalloplasty - Second stage
(click image for larger view)

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Appearance after first stage total phalloplasty.
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Dilatation of the phallus for penile prosthesis insertion. Flap harvesting.
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Semirigid penile prosthesis implantation. (dorsal approach)
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Closure of the phallic base.
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Reconstruction of distal urethra: buccal mucosa graft stage I.
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Glans reconstruction.

Case 3 Total phalloplasty with metoidioplasty (click image for larger view)

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Appearance before FTM SRS.
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Genital flaps for urethral lengthening.
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Genital flaps for urethral lengthening.
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Perineal reconstruction. Scrotoplasty with silicone testicle implants.
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Design of the latissimus dorsi muscle flap.
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Direct closure of donor site.
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Microvascular anastomosis of the flap blood supply and recipient blood vessels.
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Appearance after complete surgery.
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Appearance two weeks later: phallus has survived.

Case 4 (click image for larger view)

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Outcome after phaloplasty, prosthesis implantation and glans reconstruction.
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Outcome after phaloplasty, prosthesis implantation and glans reconstruction.

Case 5 (click image for larger view)

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Results nine months after phaloplasty.
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Results nine months after phaloplasty.
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Preparation for inflatable penile prosthesis implantation and glanuloplasty.
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Outcome after surgery. Penis in erect state.

Case 6 (click image for larger view)

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Outcome one year after total phaloplasty.
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Aspect after inflatable penile prosthesis insertion, urethral and glans reconstruction. Penis in flaccid state.
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Aspect after inflatable penile prosthesis insertion, urethral and glans reconstruction. Penis in erect state.




feed1 Comments
Jake
November 09, 2011
82.132.248.225
Votes: +3

The surgery looks amazing & so do the results.
What is the waiting list like for this procedure & costs.

I've just moved to the UK, & Im very interested.

Is there an information pack you might be able to send me??

Thank you

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