[The radial forearm flap with a prelaminated urethra: analysis of complications based on the Clavien-Dindo
Anna-Marie Küntscher1, Maik Kilian2, Sascha Bull1
1Evangelische Elisabeth Klinik Berlin Plastische Chirurgie und Handchirurgie.
Abstract:
The radial forearm flap has become a standard for phalloplasty in gender confirmation surgery (gcS) from female to male (FtM). However, there is a lack of experience regarding the use of a prelaminated urethra compared with the older techniques reported by Chang and Gottlieb and Levine. This paper assesses the complications of the individual surgical steps pursuant to the Clavien-Dindo classification.
Patients And Methods:
All patients undergoing gender reassignment surgery in our department between 1 January 2011 and 30 June 2017 using a radial forearm phalloplasty with a prelaminated urethra for gcS were included in this study. The total number of patients was 39. The complications after colpectomy, urethral prelamination, phalloplasty, implantation of testicular implants and glans-plasty were assessed. The follow-up after phalloplasty ranged between 6 and 80 months and was 32 months on average. Complications were classified according to Clavien Dindo.
Results:
Phalloplasty was uneventful in 5 out of 39 patients (12.8 %). In 22 patients (56.4 %) a grade I complication occurred. Four patients (10.3 %) sustained a grade II complication, 16 (41 %) had a grade IIIb complication and one patient had a grade IV complication (2.6 %). Twenty-eight out of 39 patients (71.8 %) developed urethral fistulas in the direct postoperative course. However, only 8 of these patients (20.5 % of the total population) required surgical revision due to fistulas. Five patients developed a urethral stenosis (12.8 %) requiring surgical revision; in two of them this happened several times (8 stenoses in total). Flap losses occurred in two patients (5.1 %).
Conclusion:
Radial forearm phalloplasty with a prelaminated urethra has become a well-established procedure in female-to-male gender reassignment surgery. In our study, the rate of urological complications was significantly reduced to a level lower than those reported in previous studies. The number of fistulas was significantly reduced during our learning curve and by surgical modifications such as a visor flap at the site of the urethral anastomosis. This large series provides a database of complications classified according to Clavien Dindo for comparison with future techniques and innovations.
