Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-Male Transsexual

Transcription

1 Phalloplasty with an Innervated Island Pedicled nterolateral Thigh Flap in a Female-to-Male Transsexual *

2 326 Hasegawa et al. cta Med. Okayama Vol. 67, No. 5 (Fig. 1); we therefore dropped the idea of reconstruction using a left radial forearm free flap. search for perforators using acoustic Doppler flowmetry revealed 2 perforators at a distance one-third distal to the center of the right anterolateral thigh, and MDCT-angiography confirmed perforators at the same site (Fig. 2, 2D). In addition, MDCTangiography revealed the descending branch of the lateral circumflex femoral artery (D-LCF) with a length of approximately 15cm (Fig. 2, 2), and phalloplasty with an innervated island pedicled anterolateral thigh flap was therefore planned. The flap was designed preoperatively. The position of the perforators identified by acoustic Doppler flowmetry was marked on the skin of the right thigh, and the flap was designed such that the mark was located at its center. The flap consisted of 3 portions: a 4 15cm rectangular lateral segment for use in the construction of the neourethra; a trapezoidal medial segment with a proximal width of 12cm, a distal width of 9cm, and a length of 11cm for use in the construction of a neophallus; and a deepithelialized 1 13cm Fig. 1 Preoperative multidetector-row computed tomography (MDCT) angiography showed circulatory impairments in the left superficial and deep palmar arches. 15cm C D Fig. 2 Preoperative MDCT-angiography of the left thigh revealed the descending branch of the lateral circumflex femoral artery (D-LCF) with a length of approximately 15 cm (length from the origin of the descending branch to the skin perforator). Yellow arrow: origin of the descending branch, White arrow: skin perforator.

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4 328 Hasegawa et al. cta Med. Okayama Vol. 67, No. 5 clitoris external urethral orifice Fig. 4 The genital areaʼs condition before surgery., the external urethral orifice was seen just below the clitoris because of urethral lengthening performed 2 years earlier;, skin incision lines in the genital area. neourethra neophallus dorsal clitoral nerves LFCN nerve sutures D-LCF descending branch of lateral circumflex femoral artery and vein C Fig. 5 Intraoperative findings., a neourethra was constructed with the lateral segment of the innervated island-pedicled LT flap that was moved to the genital area;, two dorsal nerves of the clitoris were identified on both sides of the clitoris; C, a neophallus was constructed using the tube within a tube technique, and 2 lateral femoral cutaneous nerves were sutured to 2 dorsal nerves of the clitoris.

5 October 2013 Phalloplasty with an Island Pedicled LT flap in a FTMTS 329 skin graft C Fig. 6 The patientʼs condition immediately after surgery., frontal view;, lateral view; C, the flap donor site was covered with a split-thickness skin graft taken from the contralateral thigh. Fig. 7 Postoperative course., the patientʼs condition 3 weeks after surgery. The patient became able to urinate in the standing position;, the patientʼs condition 11 months after surgery. Sculpturing of the neoglans was additionally performed 10 months after the surgery.

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