Immediate pedicled gracilis flap in radial forearm flap phalloplasty for transgender male patients to reduce urinary fistula

Radial forearm phalloplasty is plagued by high rates of fistula formation. We examined the effect of placing a pedicled gracilis myofascial flap around the urethral anastomosis at the time of radial forearm flap transfer on... [ view full abstract ]

Radial forearm phalloplasty is plagued by high rates of fistula formation.
We examined the effect of placing a pedicled gracilis myofascial flap around the urethral anastomosis at the time of radial forearm flap transfer on the development of postoperative urethrocutaneous fistula.

Our aim was to investigate if using a gracilis flap wrapped circumferentially around the anastomosis of the previously extended native urethra to the radial forearm flap prelaminated neourethra, at the time of flap transfer,... [ view full abstract ]

Our aim was to investigate if using a gracilis flap wrapped circumferentially around the anastomosis of the previously extended native urethra to the radial forearm flap prelaminated neourethra, at the time of flap transfer, would lead to decreased urinary fistulas.

Twenty patients underwent neo-urethra prelamination of their radial forearm flap phalloplasty in the first stage and in the second stage flap transfer with urethroplasty between June 2012 and October 2015 and met inclusion and... [ view full abstract ]

Twenty patients underwent neo-urethra prelamination of their radial forearm flap phalloplasty in the first stage and in the second stage flap transfer with urethroplasty between June 2012 and October 2015 and met inclusion and exclusion criteria for the study. Tube within a tube radial forearm flaps were excluded. We retrospectively reviewed patients’ medical records and extracted patient demographic data, prelamination technique (mucosa, skin graft, both, or neither), and whether or not a gracilis myofascial flap was harvested at the time of flap transfer to reinforce the native and neourethra anastomosis. The chi-squared test was used to evaluate the association between the presence of a gracilis flap and fistula formation.

Main outcome measures were the presence of a urethral fistula following second stage flap transfer phalloplasty construction. Retrograde cystourethrograms and clinical exam were used to identify the presence of a fistula. [ view full abstract ]

Main outcome measures were the presence of a urethral fistula following second stage flap transfer phalloplasty construction. Retrograde cystourethrograms and clinical exam were used to identify the presence of a fistula.

The chi-square test was used to evaluate the association between categorical variables. A two-tailed p-value was calculated. Values for p [ view full abstract ]

The chi-square test was used to evaluate the association between categorical variables. A two-tailed p-value was calculated. Values for p<0.05 were considered statistically significant. Follow up time ranged from 2.5 to 25.1 months, with an average follow-up time of 14.1 month.

Nine patients received a gracilis flap as part of their primary phalloplasty operation. None of these patients developed a fistula. Eleven patients did not receive a gracilis flap at the time of initial surgery and seven developed a fistula.

In our patient series, inclusion of a pedicled myofascial gracilis flap at time of radial forearm phalloplasty with urethroplasty was associated with an absence of fistula formation. We have since made inclusion of this flap a... [ view full abstract ]

In our patient series, inclusion of a pedicled myofascial gracilis flap at time
of radial forearm phalloplasty with urethroplasty was associated with an absence of fistula formation. We have since made inclusion of this flap a standard practice for all trans-males undergoing phalloplasty with urethroplasty.