Abdominal Pubic Phalloplasty

This technique is commonly used for phallus reconstruction in transsexuals but can be modified for use in penile cancer patients although no published data are available for this group.29 The advantages of this technique are that there is no donor site defect on the arm and that the operating time is shorter. The phallus however is relatively insensate, hairy, and prone to urethral complications.29

The phallus is fashioned from a flap of anterior abdominal wall skin, 12 cm wide and 12-14 cm long, measured from the base of the penile stump (Fig. 11.23). When possible, the superficial external pudendal vessels are incorporated into the base of the flap pedicle. The urethra is fashioned from a midline strip of scrotum, incorporating the original meatus, tubed over a 16Ch catheter, and brought forward to be incorporated into the abdominal flap. After mobilizing the flap, any excess subcutaneous tissue is excised in order to give a better cosmetic appearance and facilitate tubing of the phallus (Figs. 11.24 and 11.25). The anterior abdominal wall skin is then mobilized and lateral rotation flaps utilized in order to enable primary closure of the abdominal wall skin and thereby avoid the need to skin graft the donor site (Fig. 11.26). An example of the final result following a pubic phalloplasty is shown (see Figs. 11.18 and 11.19).

The subsequent steps of glans sculpture and insertion of a penile prosthesis are similar to the forearm flap phalloplasty described above.

Neourethra FemaleAbdominal Flap Phalloplasty

Fig. 11.24 The abdominal flap is raised and the scrotal flap tubed to form the neourethra

The main complications with this technique relate to the urethra which is at risk of sacculation and stricturing.29 An alternative technique is to fashion a neourethra as a free flap from the forearm and insert it tubularized inside the abdominal phalloplasty as described by Dabernig which yields excellent functional results with low complication rates but at the expense of an additional surgical procedure22 (Figs. 11.27-11.29).

Fig. 11.25 Flap mobilized, defatted, and urethra incorporated before tubing

Fig. 11.25 Flap mobilized, defatted, and urethra incorporated before tubing

Abdominal Flap Phalloplasty
Fig. 11.26 Abdominal closure with rotation flaps demonstrated in a transsexual patient
Pubic Phalloplasty
Fig. 11.27 Dimensions of the forearm flap urethra
Pubic PhalloplastyPhalloplasty ComplicationsPhalloplasty Abdominal Flap
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