You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-04 MUSCULOCUTANEOUS LATISSIMUS DORSI PHALLOPLASTY: TECHNIQUE AND TIPS Aditi Valada, Rajveer S. Purohit, and Miroslav L. Djordjevic Aditi ValadaAditi Valada More articles by this author , Rajveer S. PurohitRajveer S. Purohit More articles by this author , and Miroslav L. DjordjevicMiroslav L. Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Musculocutaneous latissimus dorsi (MLD) phalloplasty is a gender affirming surgical option for transmen which permits penile prosthesis, glansplasty, and urethral extension at later stages. This surgery allows for a neophallus of adequate length and girth, and minimal donor site morbidity, but is technically complex. This video demonstrates a step-by-step technique and tips to optimize outcomes and simplify the operation for the MLD phalloplasty. METHODS: A 33-year-old transmale who previously underwent metoidioplasty presented for a MLD phalloplasty. With the patient in a supine position, the superficial femoral artery (SFA) and saphenous vein (SV) are isolated at the recipient site. The patient is repositioned into a lateral flank position, the flap tubularized, and inferior aspects of the wound closed prior to harvesting the thoracodorsal artery (TDA) and vein (TDV) to minimize cold ischemia time. The thoracodorsal artery and vein are dissected to their root at the subscapular artery and vein and removed with a patch of the subscapular artery. After the neophallus is harvested, the TDA and TDV are isolated and irrigated with a heparinized saline flush. The phallus is attached to the previously created recipient site and an end-to-side anastomosis is created between the SFA and TDA and an end-to-end anastomosis between the SV and the TDV. If the patient has a thick latissimus dorsi muscle or subcutaneous fat, a split-thickness skin graft can be used to close the ventral phallus to minimize tension on the tubularized neophallus. Positioning and close post-op monitoring of the neophallus are critical. RESULTS: A neophallus of adequate length and girth is created with the option for future urethral extension and penile prosthesis placement. CONCLUSIONS: Our video demonstrates the technique for a gender affirming MLD phalloplasty in a transman and tips to optimize outcomes and simplify the operation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e552-e552 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditi Valada More articles by this author Rajveer S. Purohit More articles by this author Miroslav L. Djordjevic More articles by this author Expand All Advertisement Loading ...