The novel use of virtual surgical planning in radial forearm phalloplasty

Phalloplasty has become an increasingly prevalent component of gender affirming surgery in recent years. While it is most commonly performed using a radial forearm free flap (RFFF) due to the thin and pliable nature of this tissue, the large surface area of tissue traditionally required to create a phallus often incurs a tremendous donor site morbidity. The dimensions of the flap size needed have been traditionally estimated by the surgeon at the beginning of the case, but can be inaccurate as they do not take into account the soft tissue thickness as it relates to the girth of the arm. Thus, there can be a tendency to overestimate or underestimate the amount of tissue needed, thus increasing the donor and flap morbidity. In order to improve the accuracy of these dimensions and facilitate the minimization of tissue harvest as well as improve operative efficiency, we propose the first use of virtual surgical planning (VSP) in RFFF phalloplasty, and we describe its use in this case series. Using CT-guided analysis that takes into account extremity girth and three-dimensional soft tissue measurements, a precise and sterilizable template is created for use in surgical planning. This novel application of VSP in RFFF phalloplasty has the potential to both decrease operative time and donor site morbidity.