Phalloplasty

Is a surgical procedure performed in order to reconstruct, create or restore penis.

Nowadays, modern phalloplasty mostly involves using free vascularized back or radial auto implants. The mostly spread problem which occurs are neo-urethra formation and neo-phallus splinting.

We have elaborated original technique of one-moment total phalloplasty on the basis of methods of transplanting various vascularized grafts. This method maximally complies with modern phalloplasty demands.

In order to form neo-phallus we use aforesaid vascularized auto transplants and blood supplied third finger of non-dominant hand in order to give neo-phallus rigidity and form neo-urethra from finger’s skin.

In order to strengthen erogenous sensitivity in a case of transgender patients we exteriorize clitoris to the external surface of neo-phallus base.


Scheme of neo-phallus from auto transplant taken from the back. Clitoris is exteriorized to the front surface of neo-phallus.

 


Neo-phallus splinting using third finger auto transplant.

It is quite well-known that after transplanting finger auto transplant:

  • No resorption of bone phalanx is formed.
  • Neo-phallus is rigid and mobile at one-moment.

Using skin of finger auto transplant in order to form neo-phallus can prevent such complications as problems with urination, related to hair growth.


Formatted neo-phallus, containing radial graft, finger auto transplant phalanx and neo-urethra.

 


In order to form neo-urethra on the volar surface of third finger of non-dominant hand skin incision is made. Skin grafts are turned inside out in dorsal surface and sewed in each other on the catheter.

 


Finger auto transplant is transferred to radial auto transplant area with graft vessel anesthetizing.

 


Neo-phallus transplanting to recipient zone with blood supply restoration.

This way, this method gives the opportunity to perform full-value phalloplasty in one step.

We believe that using third finger of non-dominant hand in order to construct and reconstruct phallus give the possibility to recover its biochemical functions in one surgical interference and meets modern phalloplasty demands.

Short interview with the patient, who had phalloplasty 6 years ago

— How do you think was it worth for you to have such an operation?

He smiles.

— I’m alive and happy of living. I’m 71 and my life is full of joys, and if I didn’t do that I don’t know if I’d be able to talk to you know, doctor! Thank you so much! And as to my finger, well, I already forgot that I ever had it.

History

First phalloplasty was performed by F.K. Bessel-Hagen (1856-1922) in the beginning of last century. In order to form phallus he used pubis tissues.

In 1936 N.A. Bogoraz restored penis after its traumatic loss. His method was 5-step operation performed during 4 months.

I. Kaplan in 1971 and M. Orticochea in 1972 proposed skin-muscular grafts rotation in order to form neo-phallus.

D.R. Laub in 1974 and 1979 described his experience of phalloplasty performed to 48 transsexuals. He constructed neo-phallus in three steps using abdominal graft.

However, coming from collective experience in cases of nuclear transsexualism and subtotal amputations of penis, possibility of its lengthening or formation using local tissues is very problematic and practically the only way of patients rehabilitation is microsurgical method of reconstruction and construction using various combinations of vascular auto transplants transplantation.

First phalloplasty using groin graft was performed by C.I. Pucet in 1983. For the purpose of giving it rigidity prosthesis was put into neo-phallus.

T.S. Chang and W. Y. Hwang used free vascular radial auto transplant in 1984.

I. Kochima and co-authors proposed using vascular radial auto transplants with cortical plate of radial bone.

Later on, were proposed various methods of neo-phallus formation using various vascular grafts.

For the purpose of giving neo-phallus more rigidity G. Sun and J. Hung used vascular auto transplant from groin with iliac bone fragment in 1985.

R.C. Sadove and co-authors used skin-bone paroneal au transplant in 1993.

This way, in order to splint neo-phallus was used silicone prostheses and bone or cartilage auto transplants.

However D.A. Gilbert as far back as 1988 noticed that problem of using endoprostheses was bad vascularization and sensitivity in distal part of neo-phallus, which can cause erosion under prosthesis pressure, which leads to erosion and rejection of implants.

I. Koshima described his observations in 1986. He noticed that a year after phalloplasty using skin-bone radial auto transplant bone fragment resorption was seen on x-ray.

G.J. Alter and co-authors in 1995, mentioned that vascular bone auto transplants unavoidably undergoes resorption and prostheses undergo rejection.

In 1994 N.O. Milanov and R.T. Adamyan developed phalloplasty method using free vascular auto transplant from the back with re-innervation of moving nerve from the back, which gave the opportunity to restore moving function of muscular basis of neo-phallus, which itself gives the possibility to imitate erection. However, according to authors, nerve re-innervation might not always occur, which in future needs endoprosthetic of neo-phallus.

For the purpose of neo-urethra formation free vascular radial auto transplant is most frequently used. Though, this method is mostly performed postponed, related to problem of hair growth on transplant skin, which itself causes problems with urination.

Modern demands for phalloplasty are:

  • One-step interference.
  • Ensuring enough tactile and erogenous sensitivity.
  • Formation of full value urethra.
  • Enough length and rigidity for performing full value intermission.
  • Neo-phallus must be aesthetically acceptable for patient and partner.
  • Minimal traumatic of donor zones.

Nowadays, modern phalloplasty is mainly performed using free vascular radial and auto transplants from the back. Universally recognized problem of interference remain neo-urethra formation and neo-phallus splinting.

Our method gives the possibility to form neo-phallus with all its functions: rigidity, urination, aesthetic aspect in one-step.

Indications

Indications for phalloplasty are: sex changeling for transsexuals, traumatic injure of penis, or malignant neo-formations. It is possible to perform as full construction of neo-phallus, as reconstruction of injured penis, too.

Operation

Operation is held under general anesthesia for 7-15 hours.

Incisions are made in graft zones (forearm, hand, and thigh). While the operation drainage tubes can be installed, which are removed in 2-5 days.

Post-operation Period

Patient is discharged to ambulatory treatment 5-10 days after the surgery.

Gets back to work 3-4 weeks after the surgery.

Sutures are taken off in 10-12 days.

Driving is allowed after 2-3 weeks.

Heavy activity is limited for 1-2 months.

Scars are finally formed 12 months after the surgery.

Photogallery

Patient 1


Patient transsexual F/M, 37 years, which beforehand has had mastectomy and hysterectomy in other treatment center. Patient with pre-operation marks.


Patient 6 months after the surgery. As seen from the image, neo-phallus has enough rigidity.

Patient 2


Left – 18 years-old patient with urinary bladder ectopia, penis underdevelopment. Right – Patient 3 days after the one-step phalloplasty using vascular radial and finger auto transplants.


Patient 5 years after the surgery. Neo-phallus has enough rigidity. Donor hand is fully functioning.

Patient 3


62-years old patient. 2 years later he had subtotal penis amputation, related to malignant neo-formations. In order to form neo-phallus was used vascular radial and finger auto transplants.


Patient 1 month after the surgery, free urination is observed.


Patient 10 years after the surgery, free urination is observed.


Phalanxes of finger auto transplant are well seen on x-ray.

Patient 4


20-years old patient, has undergone treatment and surgery connected to impotence. In order to give neo-phallus rigidity vascular finger auto transplant was used.


Phallus 3 years after its splinting with vascular finger auto transplants. Enough rigidity is observed.


Finger phalanxes are seen on x-ray image.


Donor hand 3 hours after the surgery is fully functioning.