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The surgical outcomes of radial artery forearm free-flap phalloplasty in transgender men: single-centre experience and systematic review of the current literature

International Journal of Impotence Research volume 33, pages 737–745 (2021)Cite this article

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Abstract

Radial artery forearm free-flap (RAFFF) phalloplasty is considered by most authors as the gold-standard technique for genital gender-affirming surgery (GGAS). RAFFF surgical complications have rarely been investigated, and the aim of this study and literature review is to analyse and focus on the surgical technique and its postoperative vascular complications. From May 2016 to January 2020, a consecutive series of 25 transgender men who underwent GGAS were enrolled in the present study. Age, BMI and smoking habits were recorded for all patients. Overall, vascular flap complications occurred in 20% of cases. Complete flap loss due to acute arterial thrombosis was recorded in a single case (4%). In 8% of cases, limited ventro-proximal arterial ischaemia was detected, while in the remaining 8% of cases, venous ventral ischaemia was reported. These results were compared with the current literature results. Indeed, from our analysis, the number of flap veins (<2) was the only predictive factor for vascular complications. In conclusion, RAFFF represents a reliable option for total phallic construction, leading to satisfactory results in terms of flap survival. To optimize the surgical outcomes, venous vascular drainage should be recommended.

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Fig. 1: Steps of total phallic construction.
Fig. 2: Steps of total phallic costruction.
Fig. 3: Vascular complications.

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Acknowledgements

We would like to express our great appreciation to all physicians involved in this study for the great interest demonstrated towards this ambitious project and the accuracy demonstrated in collecting data.

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Authors and Affiliations

  1. Department of Neurourology, Unità Spinale Unipolare, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy

    Marco Falcone

  2. Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy

    Marco Falcone, Mirko Preto, Massimiliano Timpano & Paolo Gontero

  3. Department of Orthopedic, Microsurgery Unit, CTO Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy

    Davide Ciclamini, Francesco Giacalone & Bruno Battiston

  4. Hand Surgery and Reconstructive Microsurgery Department, CTO, ASST Gaetano Pini, Milan, Italy

    Alessandro Crosio & Pierluigi Tos

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  1. Marco Falcone
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Correspondence to Marco Falcone.

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Falcone, M., Preto, M., Timpano, M. et al. The surgical outcomes of radial artery forearm free-flap phalloplasty in transgender men: single-centre experience and systematic review of the current literature. Int J Impot Res 33, 737–745 (2021). https://doi.org/10.1038/s41443-021-00414-x

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