CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2022; 07(02): e13-e26
DOI: 10.1055/s-0042-1748884
Original Article

A Systematic Review of Staging and Flap Choice in Gender-Affirming Phalloplasty

Catherine A. Wu
1   Harvard Medical School, Boston, Massachusetts
,
Divya Jolly
2   Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
,
Elizabeth R. Boskey
2   Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
3   Department of Surgery, Harvard Medical School, Boston, Massachusetts
4   Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
,
Oren Ganor
2   Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
3   Department of Surgery, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Funding None.

Abstract

Background As phalloplasty becomes more routinely performed, there is a growing need for an evidence base to guide surgical decision-making. Recent reviews have suggested that flap type and number of stages may affect the high rates of urethral complications seen with phalloplasty, but no rigorous comparison of both has been performed.

Methods A systematic review was conducted across PubMed, Google Scholar, and ScienceDirect (PROSPERO #158722). All included studies examined urethral complications following gender-affirming phalloplasty in transgender men. Data were extracted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations system. All searches, extractions, and grading were completed by two authors.

Results Twenty-five studies were included with a total of 1,674 patients. Identified flap types included radial forearm, anterolateral thigh, abdominal, and fibular flaps. Surgical techniques varied widely within the flap types. Number of stages ranged from one to four. Stricture and fistula were the most frequently reported complications with considerable variation in the reported rates between studies, even within singular flap types. Data extraction indicated serious quality issues with the published literature, with the majority of studies at high risk of bias due to short follow-up times, inconsistent and incomplete reporting of outcomes, and inconsistent reporting of surgical technique.

Conclusion To date, there is insufficient data to support a preferred flap type to minimize the urethral complication rates of phalloplasty. Further high-quality literature is required to determine the impact of potential factors affecting complications of gender-affirming phalloplasty. Improved literature quality may be facilitated by a standardized set of reporting guidelines.



Publication History

Received: 29 December 2021

Article published online:
01 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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