Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Penile Reconstruction
Clinical Presentation
A 14-year-old intersex White person had been born with ambiguous genitalia. The patient decided to be a male but unfortunately all male genital organs had been removed at a young age. The patient now strongly desired a transformation from female to male and was seen by the pediatric urology service for a total penile reconstruction ( Fig. 38.1 ). The plastic surgery service was asked to perform a microvascular penile reconstruction in conjunction with the patient’s entire surgical care for penile reconstruction.
Operative Plan and Special Considerations
There are several options with a microvascular flap for total penile reconstruction. Among them, free radial forearm flap or free fibular osteocutaneous flap is the common option. However, free fibular osteocutaneous flap can provide a total penile reconstruction without the need for a penile implant. In addition, urethral reconstruction can also be done within the flap to provide a more functional reconstructed penis. In this case, a two-stage reconstruction was planned. During the first stage, a prefabricated urethroplasty was designed and performed in the proposed free fibular osteocutaneous flap donor site so that urethral reconstruction could be accomplished first. The formal penile reconstruction was performed during the second stage and a free fibular osteocutaneous flap was dissected out and a reconstructed penis could be created. This type of penile reconstruction may prevent future implant extrusion that might be experienced after a free radial forearm flap for a total penile reconstruction. Preoperative arterial angiogram would be needed to make sure there was normal vascular anatomy of the selected lower leg for a free fibular osteocutaneous flap donor site.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here