AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Long-Term Follow-up of Total Penile Reconstruction with Sensate Osteocutaneous Free Fibula Flap in 23
Biological Male Patients
Institution where the work was prepared: Gulhane Military Medical Academy. Depart. of Plastic Surgery, Ankara, Turkey
mustafa Sengezer, Professor; serdar ozturk; mustafa deveci; fatih zor; Gulhane Military Medical Academy
PURPOSE:
Surgical reconstruction of the penis is challenging because of the many cosmetic and functional (e.g., sexual intercourse and voiding) requirements that must
be addressed.
MATERIALS & METHODS:
Since 1994, 23 biologically male patients with total penile losses for various reasons were treated with free sensate osteocutaneous fibula flaps. The ages of
the patients ranged between 20 and 27 years (mean, 23.2 years). The average follow-up period was 7.2 years (range, 1 to 12 years). Patient satisfaction was
evaluated by a questionnaire regarding both quality of orgasm and daily activities. Conventional radiographic imaging, magnetic resonance imaging, and bone
mineral densitometry were performed to evaluate the fate of the bony component. Sensibility was evaluated by bulbocavernous reflex and penile somatosensory
evoked potentials.
RESULTS:
Eight patients married, and six of them had eight children. Most patients and their partners reported pleasurable sexual intercourse and orgasm. Conventional
radiographs of the fibular bone in neophalluses showed robust, calcified bone structure without any evidence of bone resorption or fracture. The magnetic resonance
images showed the cortical substance and spongiosum of the bone marrow, which are characteristic signs of bone viability. Viability of neophallus bone
was shown even at 11-year follow-up (the longest follow-up in the literature). Dual energy x-ray absorptiometry measurements of the penile bone grafts showed
that fibular components in the penis had bone mineral density values that were close to the normal subjects.These results were considered as evidence of viability
of bone grafts. Neural integrity was found between the nerves of the neophallus and the residual penile bodies.
CONCLUSIONS:
Free sensate fibula flap phalloplasty provides the cosmetic and functional requirements that an ideal penis should have. All results put an end to the discussion
that the fibular component of the neophallus could resorb. Constitution of neural integrity is important in terms of pleasurable sexual intercourse.
Adult and Children Total Phalloplasty
Institution where the work was prepared: Clinical Center of Serbia, Belgrade, Serbia and Montenegro
Marko Bumbasirevic, MD, PhD1; Miroslav Djordjevic, MD, PhD2; Sava Perovic, MD, PhD2; (1)Belgrade University Clinical Center, (2)Clinical Center of Serbia
Introduction:
Phalloplasty is a surgical project posing considerable challenges. There are many alternatives to this procedure (groin flap, forearm flap, rectus abdominis flap,
fibula flap, latissimus dorsi flap). Our preference is latissimus dorsi flap because of good size of the neophallus.
Methods:
From April 2001 till October 2005 total phalloplasty was performed on 23 patients aged between 10 - 46 years. Indications were failed epispadias repair (6),
micropenis (4), intersexuality (1) and female transgenderism (12). A musculocutaneous latissimus dorsi free flap was harvested with thoracodorsal artery, vein
and nerve. The flap was transferred to the pubic region and anastomozed to the femoral artery, saphenous vein and ilioinguinal nerve. Two-staged urethroplasty
was performed in all patients using buccal mucosa, except three when a Mitrofanoff channel had been created previously. Penile prosthesis, either semirigid
(7) or inflatable (8) was implanted, in two cases after puberty. Cylinders were covered with vascular prostheses that imitate tunica albuginea and additionally
fixed to the periostium of the inferior pubic rami.
Results:
Follow-up was from 6 to 59 months (mean 29). Penile size varied from 13 to 17 cm in length and from 10 to 12 cm in circumference. No flap necrosis, neither
partial nor total, was noted. Urethral fistula was occurred in 4 patients and repaired six months later. The donor site healed acceptably in 17 cases while
in the remaining 6 moderate scar occurred. Penile prostheses function is satisfactory. Conclusion: Musculocutaneous latissimus dorsi flap presents good alternative
for phalloplasty that enables neophallic size as in adults.
Lymph Node Transfer for Treating Mild to Moderate Lymphoedama
Institution where the work was prepared: E-Da Hospital, Kaohsiung, Taiwan
Victoria Rose, MBBS, MD, FRCSpl; Guan-Ming Feng; Samir Mardinis; Hung-Chi Chen; E-Da Hospital
There are many options for treating limb lymphoedema however the various modalities each have specific limitations. Lymph node transfer has been shown to
reduce the frequency of cellulitis in animal models. This study attempted to evaluate the efficacy of this treatment option in a clinical setting. During a 2 year
period 15 patients with mild to moderate lymphoedema underwent lymph node transfer. All patients were assessed prospectively. After a 3 year follow-up,
average reduction in skin tonacity was 47.46% (range 17.85 to 87.76%) and average reduction in limb circumference was 50.28% (range 33.68 to 69.44%).
Those with upper limb involvement experienced both better results for reduction in skin tonacity and limb circumference compared to those with lower limb
involvement.
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