A true one-stage nonmicrosurgical technique for total phallic reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Urology

Background:

• Phallic reconstruction aims to restore function and appearance after congenital anomalies or trauma.
• Traditional methods often require multiple stages and microsurgical expertise.
• A simplified, one-stage approach is highly desirable for improved patient outcomes.

Observation:

• A novel technique, the "Istanbul on the thigh" flap, combines an innervated anterolateral thigh (ALT) flap with a sartorius perforator flap.
• This chimeric flap is based on the lateral circumflex femoral vessels and tunneled for reconstruction.
• The procedure creates a neourethra, neophallus shaft and glans, incorporates a penile prosthesis for rigidity, and coapts nerves for erogenous sensibility.

Findings:

• A 15-year-old male underwent successful one-stage total phallic reconstruction using this technique.
• Two-year follow-up demonstrated an aesthetically acceptable and functional neopenis with a competent urethra, erogenous sensitivity, and rigidity.
• No complications were reported, and the donor scar was well-concealed.

Implications:

• This nonmicrosurgical technique offers a safe, efficient, and timesaving alternative for phallic reconstruction.
• It potentially expands reconstructive options for patients lacking access to microsurgical expertise.
• Further clinical evaluation is warranted to establish its broader utility in phallic reconstruction.