Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation

Area of Science:

• Urology
• Microsurgery
• Reconstructive Surgery

Background:

• Iatrogenic penile loss is a rare but devastating complication.
• This case details the deferred total penile reconstruction for a genetic male following penile abscess and necrosis.

Purpose of the Study:

• To present a challenging case of deferred total penile reconstruction.
• To evaluate the efficacy of radial forearm free flap (RFFF) phalloplasty and prosthetic implantation in restoring function after penile loss.

Main Methods:

• A 57-year-old male underwent staged reconstruction including abscess drainage, debridement, and phalloplasty with RFFF and neourethra construction.
• A customized inflatable penile prosthesis was implanted 18 months post-phalloplasty.
• Microsurgical techniques and skin grafting were employed during reconstruction.

Main Results:

• The patient regained penile sensitivity and achieved satisfactory aesthetic and functional outcomes with the prosthesis.
• A complication of hair growth in the neourethra required endoscopic depilation.
• The patient reported satisfaction with urinary and sensory function and is gaining confidence for penetration.

Conclusions:

• Phallic reconstruction with RFFF and prosthetic implantation is a viable option for restoring urinary and sexual function after penile loss.
• Despite potential complications and the need for multiple surgeries, this approach can significantly improve patient quality of life.
• Deferred reconstruction can yield positive functional and aesthetic results.