As we have known that phalloplasty is a medical surgery to construct, reconstruct, or modify a person’s penis, phalloplasty is mostly performed with skin graft. There are six further methods of phalloplasty, explained below:
Graft from the arm
Graft from arm is actually the easiest method to perform phalloplasty, but it leaves scar on arm—which can not be hidden. Moreover, the function of the arm may be worse if it does not heal properly. A full scale metoidioplasty can be performed several months earlier before phalloplasty. This is to decrease the complications possibilities after the surgery.
Below is the most common steps of this method of phalloplasty. Some variations may apply, but mostly below is the general approaches:
- After the patient is prepared, the surgery starts by marking the forearm with the size of the graft. The graft is then taken. In case the graft is too large, another graft from other parts of the body may be used to reconstruct the arm.
- The graft skin is then separated to see the veins and several antebrachial nerves. This is performed very carefully.
- The urethra and the phallus will be joined at this step, if both requires construction at the same time. If they don’t, the glans is formed.
- To let the joining of the graft and the existing tissues joined easily, a part of vein around the patient’s groin is used.
- The vein is placed to the femoral artery very carefully.
- The flap and the vein to the femoral artery are then joined.
- The ligament and clitoral hood is removed, while the nerve bundle is being untouched for some moments. Some surgeons make an alternative of leaving the clitoral tissue as it is after metoidioplasty.
- Some part of the flap is then placed as the nerve bundles are joined.
- If there is an urethral extension required, the urethra is joined with a catherer. It will be kept in place for two until four weeks recovery. The skin sometimes need to be sealed and the scrotum is also made up.
Moreover, if the urethra extension is required until the top of the glands of the new penis, a mixture of saline and epinephrine is injected to the labia minora. It is then opened up, and the layers are separated. The layers are then closed around a catheter and sewed up.
Sometimes, in an urethral extension, a mucosal flap from inside the vagina may be used. This requires a separate surgery.
Graft from the side of the chest
Graft from chest is actually not an old method. This is one of the biggest advancement in phalloplasty. Some advantages of this methods are good appearance, no prominent scar, lower potential of complications, and no need of hair removal. This method of phalloplasty requires three parts, spanning over six to nine months. The steps are:
- The surgery starts (after the patient is prepped) with the side of the chest marked for graft size.
- After the patient is prepared, the surgery starts by marking the side of the chest with the size of the graft. The graft is then taken.
- The graft skin is then separated to see the veins and several thoracodorsal nerves.
- With the graft still attached to the blood supply from the vein, the graft is rolled to shape a rough penis.
- To let the joining of the graft and the existing tissues joined easily, a part of vein around the patient’s groin is used.
- The vein is placed to the femoral artery very carefully.
- The flap and the vein to the femoral artery are then joined.
- The ligament and clitoral hood is removed, while the nerve bundle is being untouched for some moments.
- Some part of the flap is then placed as the nerve bundles are joined.
- The new penis is protected from any contact to other muscles and skins during the beginning recovery period. This step requires a constructed dressing to keep away any potential complications of blood supply
- Urethral extension is then started after three months pass.
- The new penis is separated and an oral mucosa graft is laid onto the cavity and extended to the urethra. Both are then joined to let urination while standing.
- A catheter is placed for several weeks to allow for proper healing
- For recovery, a catherer is used for some weeks. After three until six months, the erection device can be placed.
Graft from leg
This method is akin to that of forearm graft, except that the scar of the donor will be easily hidden by socks or pants. The remaining steps are similar to as in the forearm graft method, including the removal of permanent hair before the operation. Sometimes, the graft from the leg may be combined with forearm graft to reshape the glans penis.
Pubic area flap
Graft is taken from the skin around the pelvic bone, across the abdomen around the stomach. There will be a big horizontal scar, making it a little bit unaesthetic. Moreover, the grafts are usually seen unnatural and less permanent to keep an erecticle implant for a further term. Hair removal is necessary before proceeding this method.
Gillies technique
This method of phalloplasty is actually the first phalloplasty method ever used. An abdominal skin is rolled, making a form of tube, to simulate a natural penis. Urethral extenion is performed in another part of the skin, creating a tube within a tube. A flexible rod is required to implant erectile. A more improved method of Gillies technique includes an inclusion of a blood supply pedicle to avoid dead tissue before being transplanted to the groin.
Abdominal muscle
This last method of phalloplasty is rarely undergone. There are three minimum steps in this method, including implantating an expansion balloon to help grafting the necessary skin parts. Finally, the grafts will be a little bit unnatural, and less likely to keep the implanted erectile in a further term.
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