The Pedicled Anterolateral Thigh Flap for Phalloplasty: The Athenian Experience

In terms of preoperative planning and surgical procedure, phallus reconstruction (phalloplasty) in transgender men is an extremely difficult treatment, and numerous operating techniques have been previously documented. Here, we present the first reported case in Greece of a phalloplasty using a pedicled, aesthetically innervated anterolateral thigh (ALT) flap while maintaining the neourethra, which was constructed previously as part of metoidioplasty gender-affirming surgery. Both procedures were performed by the same senior surgeon in a 32-year-old patient. There were no intraoperative complications, and the operative duration remained within the expected range. When used as a salvage technique in a preoperated case with altered vascular anatomy, the advantages of a pedicled transposition over a free flap transplant are obvious and need to be addressed. Alone, the lack of microvascular anastomoses has the advantages of a shorter operation time and lack of potential post-operative complications. In conclusion, we view our phalloplasty procedure as a suitable substitute for existing treatments in some patients with regard to operating time, effort time, complications, donor-site morbidity, and cosmetic outcome.