Abstract
Total phalloplasty in transgender individuals is the only option to create a penis large enough for successful intercourse. There are multiple techniques described, but each has certain disadvantages which may limit some of the goals of penile reconstruction. For this reason, our preferred technique is the musculocutaneous latissimus dorsi (MLD) flap.
Phalloplasty is a staged procedure. The flap transfer is performed in the first stage, urethroplasty is performed in the second stage, and implantation of the penile prosthesis is performed in the third stage. Placement of testicular implants and glansplasty may be performed in the second or third stage. We began this approach 18 years ago, and the technique has evolved to the current approach over the last 10 years. In addition to transgender individuals, MLD phalloplasty is also performed in trauma patients, patients with congenital deformities such as micropenis, or in patients who have sustained iatrogenic penile damage usually after epispadias or severe hypospadias repair.
Phalloplasty is a complex, staged procedure, which, in the majority of patients, can provide satisfactory functional and aesthetic outcomes.
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Borgoras NA. Plastic reconstruction of penis capable of accomplishing coitus. Zentralbl Chir. 1936;63:1271.
Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74:251–8.
Biemer E. Penile construction by the radial arm flap. Clin Plast Surg. 1988;15:425–30.
Sadove RC, Sengezer M, McRoberts JW, Wells MD. One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap. Plast Reconstr Surg. 1993;92:1314–23.
Khouri RK, Young VL, Casoli VM. Long-term results of total penile reconstruction with a prefabricated lateral arm free flap. J Urol. 1998;160:383–8.
Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg. 2006;59:153–7.
Stenzl A, Ninkovic M, Willeit J, Hess M, Feichtinger H, Schwabegger A. Free neurovascular transfer of latissimus dorsi muscle to the bladder acontractility. I. Experimental studies. J Urol. 1997;157:1103–8.
Stenzl A, Ninkovic M, Kolle D, Knapp R, Anderl H, Bartsch G. Restoration of voluntary emptying of the bladder by transplantation of innervated free skeletal muscle. Lancet. 1998;351:1483–5.
Stenzl A, Schwabegger A, Bartsch G, Prosser R, Ninkovic M. Free neurovascular transfer of latisstmus dorsi muscle for the treatment of bladder acontractility: II. Clinical results. J Urol. 2003;169:1379–83.
Djordjevic ML, Bumbasirevic MZ, Vukovic PM, Sansalone S, Perovic SV. Musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children. J Pediatr Urol. 2006;2:333–9.
Baudet J, Guimberteau J, Nascimento E. Successful clinical transfer of two free thoraco dorsal axillary flaps. Plast Reconstr Surg. 1976;58:680–8.
Lassen M, Krag C, Nielsen I. The latissimus dorsi flap. An overview. Scand J Plast Reconstr Surg. 1985;19:41–51.
Manktelow RT. Microvascular reconstruction. Berlin-Heidelberg: Springer-Verlag; 1986.
Cormack GC, Lamberty BG. The arterial anatomy of skin flaps. 2nd ed., revised. Edinburgh: Churchill Livingstone; 1994.
Perovic S. Phalloplasty in children and adolescent using the extended pedicle island groin flap. J Urol. 1995;154:848–53.
Gilbert DA, Jordan GH, Devine CJ Jr, Winslow BH, Schlossberg SM. Phallic construction in prepubertal and adolescent boys. J Urol. 1993;149:1521–6.
Gilbert DA, Jordan GH, Schlossberg SM, Winslow BH. Forearm free flap for pediatric phallic reconstruction. In: Erlich RM, Alter GJ, editors. Reconstructive and plastic surgery of the external genitalia. Philadelphia: W.B. Saunders Company; 1999. p. 327–34.
Hoebeke P, de Cuypere G, Ceulemans P, Monstrey S. Obtaining rigidity in total phalloplasty: experience with 35 patients. J Urol. 2003;169:221–3.
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Djinovic, R. (2020). MLD (Musculocutaneous Latissimus Dorsi) Phalloplasty. In: Schechter, L. (eds) Gender Confirmation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-29093-1_18
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DOI: https://doi.org/10.1007/978-3-030-29093-1_18
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