Abstract
INTRODUCTION: In most female-to-male transsexual patients the construction of an aesthetic and functional neo-phallus after penile amputation represents the terminal step in a series of invasive and non-invasive procedures. For this surgery, a lot of different techniques have been described. Among these microsurgical free-flap phalloplasties remain the most popular method in clinical routine. For many years, the radial forearm free flap has been considered to be the best procedure. With the aim to reduce donor site morbidity and to optimize functional outcome many other flaps have been developed. Therefore, pedicled flaps have shown to be reliable and to decrease the risk of total failure. RESULTS: We describe a new “tube- in tube” technique combining either a pedicled SCIP (Superficial circumflex iliac artery perforator) flap or a free RFF (radial forearm) flap with an ALT (Anterolateral thigh flap) free flap. By using the SCIP/ radialis flap as part mobile of the Urethra the inner tube is formed. The ALT flap builds the outer tube. By presenting cases of this technique, first experiences, outcome and the most occurring complications should be showed. CONCLUSION: By combining the reliability of pedicled flaps with the benefits in aesthetic outcome of free flaps, this new “tube- in- tube” technique represents a method to reduce complete flap failure by simultaneously decrease complication rate.
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