Recipient Vessel Selection in Free Flap Phalloplasty: A Systematic Review and Single-Arm Meta-Analysis

Area of Science:

• Microsurgery
• Vascular Surgery
• Plastic Surgery

Background:

• Recipient vessel selection is a critical challenge in phalloplasty due to limited vessel availability.
• No established consensus exists for optimal recipient vessel choice in phalloplasty procedures.

Purpose of the Study:

• To investigate the association between recipient vessel selection in phalloplasty and complication rates, including flap survival.
• To compare outcomes associated with different recipient arteries used in phalloplasty.

Main Methods:

• Systematic literature review adhering to PRISMA guidelines across major databases (PubMed, Embase, CENTRAL).
• Data extraction included demographics, surgical details, vessel choice, graft use, and outcomes.
• Random-effects model was employed for statistical analysis of collected data.

Main Results:

• Analysis of 1976 phalloplasty cases revealed deep inferior epigastric artery (DIEA) use in 71.5% and femoral artery (FA) in 28.5%.
• Arterial and venous thrombosis rates were 2.0% and 2.2%, respectively.
• Higher arterial thrombosis (16.0%) was linked to FA with interpositional grafts/loops compared to direct FA anastomosis (0.1%) or DIEA (1.2%).
• Partial flap necrosis was less frequent with direct FA anastomosis (0.6%) versus DIEA (6.2%) when vessels remained patent.

Conclusions:

• Recipient vessel choice significantly influences phalloplasty flap survival.
• The DIEA demonstrates a low thrombosis rate, but is associated with higher partial flap necrosis when vessels are patent.
• Higher FA thrombosis rates may be due to interpositional grafts/loops; direct FA anastomosis shows favorable outcomes regarding necrosis.