Female-to-male transsexuals have been operated
on in the authors' department since 1975. Between 1981 and 1995, 46 patients
underwent neophallus construction with a free osteofasciocutaneous forearm
or fibula flap. The bony part of these flaps is embedded in tissue with
excellent blood circulation, has no contact with the skeleton, and is free
of mechanical stress. To evaluate the long-term fate of the bony component
of these flaps, the authors examined 18 of the 46 patients (39.1 percent)
who had received a neophallus by means of one of these methods (12 with
forearm and six with fibula flap) and who were willing to participate in the
updating of the results of the previous two decades; this represented a
follow-up of 5 to 112 months postoperatively (average, 27.4 months).
The following investigations were
undertaken: clinical and radiologic examination, bone scintigraphy, magnetic
resonance imaging, and histologic examination of the neophallus bony
component. In all patients, the clinical examination showed no significant
variations in the shape and rigidity of the neophallus bone. The radiologic
examination showed a compact bone structure, and the magnetic resonance
imaging proved the vitality of the neophallus in all patients, with no
significant changes over time. Bone scintigraphy did not prove to be useful
in determining the long-term fate of the neophallic bony component.
Histologically, subperiosteal neoformation
of fibrous bone was shown, whereas the lamellar cortical bone was
predominantly avital. The results of this study reveal the vitality of the
bony component in neophallus construction with free osteofasciocutaneous
flaps. Even 112 months after the procedure, it provided sufficient stiffness
for sexual intercourse. This continuing adequate rigidity of the bony
component, in addition to the well-known advantages of the free
osteofasciocutaneous flap, is further evidence of its usefulness in
neophallus construction.
Citation: Plast
Reconstr Surg 2002 Mar;109(3):1025-30; discussion 1031-2 an article
published on the Internet by PubMed <http://www.ncbi.nlm.nih.gov/>
