J reconstr Microsurg
DOI: 10.1055/s-0037-1608656
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Phalloplasty in Female-to-Male Transsexuals by Gottlieb and Levine's Free Radial Forearm Flap Technique—A Long-Term Single-Center Experience Over More than Two Decades

Anna E. Wirthmann1, Pawel Majenka1, Melanie C. Kaufmann2, Sascha V. Wellenbrock1, Lara Kasper1, Susanne Hüttinger1, Gabriel Djedovic3, Ahmet Bozkurt3, Michael Sohn2, Ulrich M. Rieger1
  • 1Department of Plastic Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany
  • 2Department of Urology, AGAPLESION Markus Hospital, Frankfurt, Germany
  • 3Department of Plastic Surgery, Helios Hospital, Wuppertal, Germany
Further Information

Publication History

12 July 2017

28 September 2017

Publication Date:
15 November 2017 (eFirst)


Background The free radial forearm flap phalloplasty is the most utilized method for penile reconstruction. Among the techniques described in the literature, evidence for the flap design after Gottlieb and Levine is poor.

Methods From January 1993 until December 2015, 402 phalloplasties were performed in our clinic. Among the 247 free radial forearm flap phalloplasties, 232 free radial forearm flap phalloplasties were performed after Gottlieb and Levine in 229 patients. Operation and patient-specific characteristics were evaluated.

Results This study presents the highest number of free radial forearm flap phalloplasties after Gottlieb and Levine. The rate of total flap failure was 3%; 46% of the patients were heavy smokers. Urinary fistulae and strictures are common. The revision rate for urinary fistulae and/or strictures was 1.3 per patient. The number of postoperative complications, such as bleeding (14.2%), thrombosis of the flap requiring revision (11.2%), or delayed wound healing (16.8%) was considering the high rate of nicotine abuse (45.9%) reasonable.

Conclusion The free radial forearm phalloplasty in the design by Gottlieb and Levine is well established at our institution and has proven safe and reliable since 1993. The operative results are satisfactory for both patients and surgeons even in the presence of relevant comorbidities and heavy smoking. We acknowledge the long ordeal and psychological pressure that our patients suffer from, before presenting in our outpatient clinic.

Ethical Approval

Obtained by the ethical committee of the federal states' medical association.