Staged phalloplasty in a transgender male: a complex case report

TL;DR

A new surgical technique for phalloplasty is described that minimizes visible scarring for transgender males.

Contribution

A novel local groin flap approach is introduced to reduce visible scarring in phalloplasty.

Findings

A staged phalloplasty approach using a lower abdominal flap was successfully used in a transgender male patient.

The technique avoids major visible scarring from traditional methods like radial forearm or anterolateral thigh flaps.

Future stages will use a skin graft from the thigh to create a urethral channel with minimal scarring.

Abstract

We present a novel local groin flap approach for phalloplasty with minimal visible scarring. The presented patient is a 32-year-old transgender male with a prior metoidioplasty. He desired phalloplasty to optimized standing micturition and sexual function but was unwilling to undergo standard radial forearm or anterolateral thigh due to high visible scar burden. A staged approach to phalloplasty was employed, using a lower abdominal random pattern flap to construct the phallus. Once healed, future stages will create a urethral channel with full thickness skin graft from the thigh to maintain a low scar burden. Although this technique does not provide an option for direct neurotization of the construct, burial of the clitoral structures is expected to provide adequate sexual function. This technique can be considered for patients who do not desire the typical visible scarring with traditional phalloplasty methods.

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