Microsurgical total phalloplasty
The thoracodorsalis flap is taken from the lateral region of the back usually from left side. In the region of the Musculus latissimus dorsi the
surgeon makes a marking and takes the thoracodorsalis flap by these marks using conventional method. For the following reinnervation the surgeon
includes the thoracodorsalis motor nerve (which operates the taken muscles) into the vascular stalk.
The flap taken by marks is rolled up and then the surgeon forms from it a new penis. The dimensions of taken flap are from 11*18 to 14*22 cm.
The donor place is taken in with using of method of rotational skin plasty with moving of lower-lateral skin-fascial flap.
For the next stage of penis reconstruction the surgeon prepares the spot for neophallos fixation on the pubis. The neophallos muscle is fixed to the
periosteum of the pubic bone. If the patient is a transsexual, then the surgeon may move the clitoris to the neophallos basis. In the case of
microphally the balanus may be moved to the new phallus. In both cases the erotic sensitivity will be keeped.
After the neophallos fixation the surgeon forms vascular microanastomoses. The microanastomoses are made between the neophallos artery and the lower
part of the epigastric artery, between the neophallos vein and the epigastric vein by separate knotty stitches "the end to the end". The
thoracodorsalis nerve is connected to the motor nerve of thigh muscle. All manipulations on the vessels and nerves are made by modern microsurgical
After the forming of anastomoses and after the reestablishing of blood flow in neophallos the surgeons take in the wounds on a thigh and on the
After the neophallos engraftment in 6 months the surgeons may make by patient's request the following stages of surgical rehabilitation:
urethroplasty (forming of urethra)
recovery of neophallos' rigidity (prosthetic devices implantation for erections imitation)
forming of balanus
The radial flap.
The radial flap is a skin-fascial flap taken on the nourishing vessels from the forearm. Using this flap, the surgeon can form a neourethra
simultaneously with phalloplasty (this operation is called "phallourethroplasty"). This fact reduces the rehabilitation time.
The operation is made by two surgeon's team. Surgeons take a complicated skin-fascial flap from the left forearm on a radial vascular stalk. This
flap consists two skin parts divided by parts of skin without epidermis. The future neourethra is a region between these parts.
The skin region for forming new balanus placed at the top of the flap.
The neophallos and the neourethra with supposed balanus are formed at the forearm region.
Then the transplant is moved to the target zone. The neourethra is connected with patient's urethra as "the end to the end", the radial nerve of
the flap is connected with the dorsalis nerve of the penis, the cutaneous stitches are put around the periphery of the wound. The artery and the vein
of the transplant are anastomosed with lower epigastral vessels. The donor zone is covered by patient's skin taken from the front-lateral side of
thigh by a skin-grafting apparatus.
This operation gives good aesthetic result and allows to decide problems of penis and urethra reconstruction. Furthermore, this operation gives to the
patient some erogenous sensitivity which is important for social and sexual rehabilitation of the patient.
I hope this broadened your field of vision,a little...