Abstract
A fundamental goal of phalloplasty includes the construction of a sensate neophallus. Both tactile and erogenous sensation are important for protective sensation (including retention of implantable penile prosthesis) as well as sexual satisfaction. This article will describe the sensory innervation of flaps commonly used for phalloplasty including the radial forearm flap, anterolateral thigh flap, and musculocutaneous latissimus dorsi flap. The sensory innervation of the perineum and external genitalia will be reviewed as a basis for selecting recipient nerves. Additionally, surgical techniques, such as neurorrhaphy, will be discussed. Finally, outcome data, although limited, will be assessed.
Highlights
Recent studies estimate that approximately 25 million individuals worldwide, including 1 million people in the United States, identify as transgender[1,2,3]
The goals of phalloplasty are well described; among these goals include the construction of a sensate neophallus, capable of providing both protective and erogenous sensation[10,11]
A common strategy designed to provide erogenous sensation in phalloplasty procedures involves the coaptation of a flap sensory nerve to the dorsal pudendal nerve or the dorsal clitoral nerve . [15,22,24,29]
Summary
Recent studies estimate that approximately 25 million individuals worldwide, including 1 million people in the United States, identify as transgender[1,2,3]. Following coaptation of the LFCN to the dorsal clitoral nerve, patients achieved tactile and erogenous sensation and reported satisfactory sexual function following surgery . The second pathway, called the “central way” is based on nerve coaptations between donor and recipient nerves This technique typically results in improved sensory recovery and forms the basis of reinnervation strategies for phalloplasty procedures [Figure 7]. Kim et al.[22] reported outcomes of 40 transgender men undergoing phalloplasty with a radial forearm osteocutaneous flap In their series, the medial antebrachial cutaneous nerve was coapted to the ilioinguinal nerve, and the lateral antebrachial cutaneous nerve was coapted to the deep pudendal or dorsal clitoral nerve. A common strategy designed to provide erogenous sensation in phalloplasty procedures involves the coaptation of a flap sensory nerve to the dorsal pudendal nerve or the dorsal clitoral nerve . Future research is required to evaluate outcomes and elucidate the role by which various nerve coaptations result in orgasmic capability[15]
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