Abstract
Background Patients with congenital or acquired penile defects face significant psychological
trauma. Various methods for penile reconstruction have been described of which the
free radial artery forearm flap using the tube-within-tube design is found to be the
most commonly used. We have assimilated the best practices described at different
times in our bid to standardize the technique and have strived to make it reproducible.
The reconstructed phalluses with this method can withstand the test of time, allowing
the patients to lead a normal life.
Materials and Methods We conducted a retrospective review of the past 16 years and collected data for all
radial forearm free flap phalloplasties. We have modified the design originally described
by Biemer. The urethra is kept 1 cm longer than the shaft and the proximal 5 mm of
the prospective urethra is not sutured to allow for spatulation of the urethral anastomosis.
Results A total of nine patients were included out of which six patients had congenital malformations,
two had traumatic injuries, and one had penile carcinoma. Six out of the nine patients
had implants placed which were wrapped in fascia lata graft. One of these patients
experienced displacement of the implant which needed to be repositioned. Three patients
faced postoperative complications. All patients had tactile and erogenous sensation
at the tip of the glans at the end of 1 year and all patients could micturate while
standing. One patient's esthetic and functional outcome was compromised. One of the
married patients has fathered a child through normal sexual intercourse.
Conclusion Radial forearm phalloplasty done by this technique allows us to achieve consistently
stable functional and esthetic outcomes. We firmly believe that this standardized
protocol for penile reconstruction could be of great benefit to patients as well as
to the treating reconstructive surgeon in their quest to achieve a completely rehabilitated
patient.
Keywords
phalloplasty - penile reconstruction - penile implant
