A New Surgical Procedure for Penile Reconstruction by Combined Free Radial Forearm Flap and Dorsalis Pedis Flap.

OBJECTIVE: To introduce a new surgical procedure for penile reconstruction, emphasizing both the aesthetic appearance and the function by combined free radial forearm flap and dorsalis pedis flap.

PATIENTS AND METHODS: In this procedure, the penis was subdivided into 2 anatomic subunits: the penile shaft and the glans penis. A sequential innervated radial forearm free flap was combined with a dorsalis pedis free flap to reconstruct the penile shaft and the glans, separately. Cartilage prosthesis was implanted at the same time. Since May 2011, 14 biologically male patients with total penile losses by various reasons were treated with this procedure. Patient satisfaction was evaluated by questionnaire, and sensory testing was performed.

RESULTS: The ages of the patients ranged between 21 and 53 years (mean, 35.2 years). The average follow-up period was 38.1 months (range, 25.5-56 months). Twenty-five flaps in 11 patients were 100% viable. One dorsalis pedis flap in a patient underwent partial necrosis. There were no cases of urethral fistula or urethral stenosis, but 1 case of prosthesis infection and 1 case of abdominal hernia were recorded. The sensation of the neophallus recovered 3-6 months after surgery, and the patient satisfaction rate was quite high.

CONCLUSION: The new surgical procedure of combined free radial forearm flap and dorsalis pedis flap for penile reconstruction achieves both satisfactory aesthetic and functional results. We recommend this procedure as an alternative ideal method for total penile reconstruction.