Sensibility following Innervated Free Radial Forearm Flap for Penile Reconstruction

Abstract

The free radial forearm flap has proven to be reliable for penile reconstruction. The purpose of this study was to determine whether neurotization of this flap improved sensation of the reconstructed penis. A long-term follow-up study of 45 patients undergoing penile reconstruction using free radial forearm flap was performed; 28 of the 45 patients received an innervated flap, and 17 received a noninnervated flap. A nerve repair between the dorsal nerve of the penis and the lateral antebrachial cutaneous nerve was performed for innervation. Sensory testing, including pain perception, temperature perception, vibratory threshold, and static two-point discrimination, was performed by one blinded examiner in a standardized pattern. Mean follow-up time was 9.1 years. Mean patient age was 26.4 years (range, 18 to 48 years). Postoperative pain perception and vibratory threshold were similar between the two groups in the proximal part of the neophallus but were significantly better in the innervated flaps (p < 0.01) in the distal part. Noninnervated flaps displayed a pattern of increasing sensibility from the distal part toward the proximal part, whereas innervated flaps regained sensation throughout. The innervated group had a better result of temperature perception and static two-point discrimination in both the proximal and the distal parts. Innervation of free radial forearm flap provides improved sensation to the reconstructed penis. If it is possible to find the functional recipient nerve, innervation should always be conducted.