COMPLETE PHALLOPLASTY WITH A PRELAMINATED OSTEOCUTANEOUS FIBULA FLAP

Abstract

pedicled skin flaps were used, followed by myocutaneous flaps. Recently microsurgical-free flaps were introduced in the mid 1980s.l While radical forearm flaps have provided an esthetically pleasing phallus, achieving rigidity with a prosthesis often leads to complications and failure.2.3 In addition the forearm flap donor site requires the loss of most of the skin of the forearm.4 In 1993 Sadove et a1 reported the first penile reconstruction with an osteocutaneous-free fibula flap.4 Results were excellent except for the development of a urethrocutaneous fistula in 2 of 3 patients in whom a neourethra had been constructed. In another patient a urethral stricture developed that required internal urethrotomy. We decribe total penile reconstruction using a prelaminated osteocutaneous-free fibula flap. The urethral reconstruction using a skin graft was tubularized and implanted in the lower leg skin before microvascular transfer. We report our modification of this technique using a prelaminated flap. Our modification uses a free gr& as the neourethra, which is transferred into a tunnel of the recipient flap on the lateral aspect of the lower leg. Three months later the neourethra and recipient flap are harvested en bloc to optimize blood supply to the neophallus and neourethra.