Phalloplasty With a Free Scapular Flap Improves Postoperative Sensation in Penile Reconstruction

Objective We aimed to evaluate both the long-term surgical outcomes and patient-reported outcomes of free scapular flap (FSF) phalloplasty. MethodThe same surgical team performed phalloplasty in 66 patients using a FSF between March 2000 and September 2018. All patients had at least 24 months of follow-up. The surgical techniques used, complications observed, and surgical and patient-reported outcomes were retrospectively described. ResultA total of 66 patients with indications of penile trauma (n = 19), micropenis (n = 42), and self-amputation (n = 5) underwent FSF phalloplasty. Two patients (3%) had total flap necrosis and 1 (1.5%) had partial flap necrosis. The urethral complication rate was 18.2% (12/66 patients). All patients were able to void while standing after revision procedures or urethroplasty. We found that an FSF is a reliable donor site for penile reconstruction.ConclusionThe FSF phalloplasty creates an esthetically pleasing penis and allows voiding while standing. Most patients can engage in sexual activity. The main drawbacks of using this method are that patients experience different degrees of sensory recovery, and patients undergoing surgery with the “tube-in-tube” technique may find they are be limited by the thickness of the flap. However, by making full use of residual tissue, such as the micropenis glans or scrotal skin, patients can obtain good tactile and erogenous sensation. We believe that using an FSF complements the existing phalloplasty techniques.

The use of a “chimeric” autotissue complex from the subscapularis vascular basin for maxillary reconstruction after malignant tumors resection

The objective of this work – to evaluate the results of reconstructive interventions using free revascularized tissue complexes of the scapular region in patients after maxillary resection for malignant tumors. Materials and methods. Between 2014–2020 the post-resection maxillary defects were replaced with free blood-sup plied flaps of the scapular region in 19 patients. In Group 1 (n = 10), the defect was eliminated after total maxillectomy with preservation of the eyeball using a “chimeric” tissue complex, parts of which were positioned in several planes. In Group 2 (n = 9), total and subtotal defects of the hard palate and alveolar process were replaced using a free flap with the inclusion of the scapula angle, which was placed horizontally. The functional and aesthetic results of the reconstructions, the degree of morphological correspondence of the reconstructed structures, as well as the incidence of postoperative complications were assessed. Results. In Group 1 total necrosis of the flap was noted in 2 cases (20 %), in 1 (10 %) case – necrosis of the skin fragment). In Group 2 graft necrosis was observed in 1 (11 %) patient. Satisfactory and excellent aesthetic and functional results were achieved in 6 (60 %) patients in Group 1 and 8 (89 %) patients in Group 2. Conclusion. The scapular flap has a number of advantages for microsurgical reconstruction, including the presence of a long vascular pedicle with large vessels, inclusion of different tissues, possibility of harvesting a “chimeric” version (with significant mobility of parts), low rate of vascular lesions in the area, and most importantly, morphologically close location of bone tissue of the scapula to the maxilla, which ensures successful application of this flap for maxillary repair in patients with advanced cancer of the upper jaw.

Free Tissue Transfer Penile Reconstruction

Phalloplasty can be a challenging plastic surgery procedure associated with complications and unsatisfactory results. Phalloplasty has become an important procedure in the setting of trauma, partial or complete excision of the penis, and gender affirmation. Advances in microsurgery has expanded penile reconstruction through free tissue transfer techniques which include the radial forearm free flap, fibular osteocutaneous flap, anterolateral thigh flap, latissimus dorsi flap, scapular flap, and abdominal flaps. Each procedure has advantages and disadvantages; most of the procedures achieve adequate cosmetic results with high patient satisfaction. Most of the surgical complications are related to the reconstruction of the urethra or creating rigidity for intercourse. The main goals of reconstruction are to create a cosmetically appealing phallus with satisfactory sexual function.