Technical Description and Microsurgical Outcomes in Phalloplasty Using the DIEA and Locoregional Veins

• Published in: Plastic and reconstructive surgery (1963)
• Main Authors: Danker, Sara, Annen, Alvin W, Cylinder, Isabel, Esmonde, Nick O, Berli, Jens U
• Format: Journal Article
• Language: English
• Published: United States American Society of Plastic Surgeons 27-04-2020
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0000000000007036

BACKGROUND:Phalloplasty often requires free tissue transfer. There is ample literature describing flap-related outcomes, but the microsurgical techniques including choice of recipient vessels have been an overlooked, yet important, topic. In this study we review the outcomes of our experience with the deep inferior epigastric artery (DIEA) and loco-regional veins and outline technical modifications that occurred during the study period
METHODS:A retrospective chart analysis of patients who underwent microsurgical phalloplasty between September 2016 and July 2019 was performed. Variables included flap design, donor site, and recipient vessels. The outcome measures were return to the operating room for flap compromise and partial or complete flap loss.
RESULTS:Forty-two phalloplasties using the DIEA were identified. There were 6 takebacks for flap compromise; 4 patients required venous revision, one of which lost his urethral flap on postoperative day 9. There was a decrease in takeback rate from 30% in the first twenty patient to 0% in the second 22 patients in the study period. A total of 11.9% of patients had partial flap loss. This only decreased from 15% to 9% in the two groups.
CONCLUSIONS:After an initial learning curve the combination of DIEA, DIEV and GSV combined with specific technical modifications such as targeted coagulation of the vasa nervorum of the clitoral nerve has proven to be a reliable technique.