ABSTRACT
Radial forearm-flap sensate free-flap phalloplasty was performed in a 32-year-old
female-to-male transsexual. An arteriovenous loop was created by end-to-side anastomosis
of the left greater saphenous vein to the femoral artery at the level of the femoral
triangle. On the first postoperative day, the neophallus showed signs of impaired
circulation, and a recent thrombus was removed from the venous pedicle. A distal fistula
between the radial artery and a superficial vein was created, converting this possibly
low-flow flap to a high-flow system. The flap could be salvaged entirely.
Taking the well-recognized, long-term complications of arteriovenous fistulas into
account, the authors do not recommend routine use of such a distal fistula. Still,
in cases where vascular patency of the venous graft is shown not to be adequate, an
adjunctive arteriovenous fistula created distally may salvage the flap.
