Comparative Study of the Free Microvascular Groin Flap: Optimizing the Donor Site After Free Radial Forearm Flap Phalloplasty.

OBJECTIVE: To improve the donor-site morbidity of the radial forearm flap through coverage with a free vascularized groin flap and comparing this flap coverage to the current standard, a full-thickness skin graft (FTSG).

MATERIALS AND METHODS: A retrospective analysis of all free radial forearm flap phalloplasties for transgender surgery at our institution was performed. We examined patient characteristics, donor site defects, surgical procedure, and clinical courses.

RESULTS: Between October 2013 and February 2016, 27 consecutive patients underwent phalloplasty for female-to-male reassignment surgery with free radial forearm flaps. A total of 7 free groin flaps (group A) and 20 full-thickness skin graft from the groin region (group B) for donor-site defect coverage of the forearm were performed. The mean age in group A was 28.4 years with a mean body mass index of 21.6 kg/m(2) and a mean follow-up time of 10.6 months. The mean surgery time was 724 minutes. The mean patients' functional rating was 3.6 accompanied by the mean patients' aesthetical rating of 3.7. The mean age in group B was 30.5 years with a mean body mass index of 23.7 kg/m(2) and a mean follow-up time of 13.4 months. The mean surgery time was 563 minutes. The mean patients' functional rating was 3.1 accompanied by the mean patients' aesthetical rating of 2.9.

CONCLUSION: We suggest that the free microvascular groin flap should be considered for immediate defect closure after phalloplasty with a radial forearm flap due to its beneficial functional and aesthetic results and the low rate of complications.