Total Phalloplasty Using A Musculocutaneous Latissimus Dorsi Flap

Main Category: Urology / Nephrology
Article Date: 16 Dec 2007 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

UroToday.com- The creation of a neophallus has been a difficult reconstructive challenge and the search for the perfect donor site and surgical procedure continues. Recently, Sava Perovic and colleagues from Belgrade Serbia, describe their experience with total phalloplasty using a musculocutaneous latissimus dorsi flap (MLD). The manuscript is published in the October 2007 issue of BJU International.

Over a 7 year period, 16 patients (mean age 24) had total phalloplasty for indications such as congenital anomalies of the penis in 12, iatrogenic penile loss in two, and accidental penile trauma in two. The MLD flap is mobilized on a subscapular artery and vein and a thoracodorsal nerve. The neophallus is created on the flank and transferred after dividing the neurovascular bundle. The neophallus is anastomosed with the femoral artery, saphenous vein, and ilio-inguinal nerve. In the following stages, two- or three-stage buccal mucosa urethroplasty were used in 11 patients; a penile prosthesis was implanted in seven.

Mean follow-up was 31 months; the neophallus was 14-18 cm long and 11-15 cm in circumference. There was no flap loss or partial skin necrosis. The donor site appearance was satisfactory in 13 patients. In two patients, there was partial wound dehiscence with moderate scarring after direct donor-site closure. The hospital stay after the first stage was 7-10 days.

There was no urethral stenosis and uroflowmetry showed good urethral patentcy in all patients. Two small urethrocutaneous fistula developed, one required an additional surgery for closure. The function of the penile prosthesis was satisfactory in all patients and three reported successful sexual intercourse. All patients were evaluated by a clinical psychologist and reported being very satisfied with the penile size and appearance.

This report, and experience in a good number of patients over a 7-year period, gives optimism to yet another attempt at finding the perfect flap site for neophallus creation. The potential advantages over the radial forearm flap are the hidden donor site scars and the size of the neophallus that can be created.

Perovic SV, Djinovic R, Bumbasirevic M, Djordjevic M, Vukovic P

BJU Int. 100(4):899-905, October 2007
doi:10.1111/j.1464-410X.2007.07084.x

Reported by UroToday.com Contributing Editor Michael J. Metro, M.D

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

----------------------------
Copyright © 2007 - UroToday
Reproduced for Medical News Today with permission of UroToday.
----------------------------