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Superficial Circumflex Iliac Artery (SCIA) perforator flap for shaft-only phalloplasty: Surgical technique and
Kristin B de Haseth1,2, Danny A Young-Afat1,2, Sterre E Mokken1
1Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Background:
Phalloplasty is the surgical (re)construction of a phallus using pedicled and/or free tissue flaps. The pedicled superficial circumflex iliac artery (SCIA) perforator flap is a novel, up-and-coming technique for phalloplasty. Here, we present our surgical technique and surgical outcomes for pedicled SCIA-based phalloplasty without urethral lengthening (i.e. shaft-only) in transgender men.
Methods:
All transgender men who underwent shaft-only phalloplasty using SCIA-based perforator flaps between January 2017 and December 2023 were included in the analysis. Participant demographics, surgical characteristics, and postoperative outcomes were assessed, including (partial) flap failure and postoperative complications.
Results:
Forty-seven transgender men were included. Median age at surgery was 30 years (range 19-61 years), and mean BMI 23 ± 2kg/m2. Average flap dimensions were 13 cm in length (range 12-15cm) and 11 cm in width (range 9-13cm). Successful penile reconstruction with a unilateral pedicled SCIA-based flap, without additional flaps or requirements, was achieved in 45 (96%) participants. One participant had total flap necrosis and one had partial flap necrosis. Primary closure was obtained in all participants (100%). Wound dehiscence was frequent at phallus/scrotum junction (n = 17), and infrequent at the donor-site (n = 3), and could be managed conservatively in all cases.
Conclusion:
The SCIA-based perforator flap is a safe and promising pedicled option for shaft-only phalloplasty, with a concealable donor site and without the need for microvascular anastomosis. Therefore, in our center, the SCIA-based perforator flap has become our primary choice for phalloplasty without urethral lengthening in slim patients.
