Reconstructive Surgery for Severe Penile Inadequacy : Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap

Abstract EN

Objectives.

Severe penile inadequacy in adolescents is rare.

Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon.

Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals.

Recently we started to use these techniques in the treatment of severe penile inadequacy.

Methods.

Eleven males (age 15 to 42 years) were treated with a phallic reconstruction.

The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient.

The RFF was used in 7 patients, the ALTF in 4 patients.

Mean followup was 25 months (range: 4–49 months).

Aesthetic and functional results were evaluated.

Results.

There were no complications related to the flap.

Aesthetic results were judged as “good” in 9 patients and “moderate” in 2 patients.

Sensitivity in the RFF was superior compared to the ALTF.

Four patients developed urinary complications (stricture and/or fistula).

Six patients underwent erectile implant surgery.

In 2 patients the erectile implant had to be removed due to infection or erosion.

Conclusion.

In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays.

The free radial forearm flap is still the method of choice.

The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.