(037) Contemporary Surgical and Functional Outcomes of Anterolateral Thigh Flap for Penile Reconstruction

Abstract

Abstract Introduction The radial forearm free flap phalloplasty is the most commonly used flap for penile reconstruction. The anterolateral thigh (ALT) free flap was proposed in 2006 as an alternative due to the twin advantages of a more easily hidden scar and improved flexibility in the length of the flap. A pedicled variant of the ALT flap was proposed the same year thus offering greater security of vascular supply for suitable patients. Previous reports have highlighted higher rates of flap loss and low rates of integrated urethra. Objective The aim of the study is to report the contemporary surgical outcomes of ALT phalloplasty. In addition, the functional outcomes of the ALT flap phalloplasty are reported for the first time. Methods All patients undergoing ALT flap phalloplasty were included in the study between 2009 and 2021. Data were extracted from a comprehensive prospective database and the medical records. Functional outcomes were assessed by non-validated questionnaire. Results Seventy-six patients underwent ALT flap phalloplasty with a mean follow-up of 34 months (SEM ± 3.05). Median age of the patients was 32 (IQR 26 – 46) and body mass index was 24 (SEM ± 0.61). A significant minority had a previous phalloplasty (22%). In addition, 7% of patients had other co-morbidities including diabetes and peripheral vascular disease. Over half of all flaps (n=41) were designed with an integrated urethra and 6.6% (n=5) required free flap transfer. The average length of stay was seven days (SEM ±0.47). Post-surgery, five (6.6%) patients experienced total flap loss, with a further three (3.9%) experiencing partial loss. Urethral complications were common with eleven (26.8%) patients developing fistulae and three (7.3%) developing strictures. Fifty-three (69%) patients completed the functional outcomes questionnaire. Forty-three (81%) were generally satisfied with their phalloplasty, while thirty-four (65%) felt they had a good cosmetic outcome. Twenty-eight (53%) had sensation in at least half of their phallus. Eight (17%) experienced troublesome post-micturition dribbling. Conclusions Presented is one of the largest cohort of patients following genital gender affirmation surgery using the ALT flap phalloplasty. Over half of all patients successfully had an integrated urethra (gold standard for urethral reconstruction). Functional outcomes (an important determinant for the choice of a flap) are reported for the first time showing 81% of patients are satisfied despite a challenging cohort with almost a quarter of patients undergoing salvage following previous failed phalloplasty. Disclosure No