6, top left and middle left). Tactile and erogenous sensitivity was also rated as excellent. Urethrography carried out by the urologists showed a stricture at the urethral anastomosis 4 months postoperatively which required an open urethroplasty. Two months later, another urethroplasty was necessary due to recurrent stricture. Twelve months postoperatively, the patient was able to urinate while standing (Fig. 6, bottom left). No donor-site complications were recorded. The patient regained full range of motion of the wrist with unimpaired

strength. No nerve-related complications were encountered. The patient was a 48-year-old female-to-male transsexual with an osteogenesis imperfecta, arterial hypertension, and a heavy smoking Nivolumab price history with chronic obstructive pulmonary disease. In this case, vaginectomy had been performed in a previous procedure combined with adnexectomy and hysterectomy. We performed the free sensate RFF-phalloplasty

from the right side using the Chang-design. The microsurgical anastomoses were performed in the right groin: the radial artery onto the common femoral artery in an end-to-side fashion, Selleckchem Erlotinib and three venous end-to-end anastomoses of the flap onto branches of the greater saphenous vein. Both antebrachial nerves were coapted to the ilioinguinal and to one of the dorsal clitoral nerves respectively. The same pharmacological and flap monitoring protocol was followed as for case 1. Starting from POD 11, a partial flap necrosis appeared, L-gulonolactone oxidase affecting the areas of the lateral flap borders. The debridement resulted in a complete loss of the neo-urethra. We decided to apply an identical approach to reconstruct the neo-phallus and the neo-urethra. The same modified, shortened Chang-designed RFF was harvested on the contralateral left forearm. The flap dimensions were identical to the ones described in case 1 (Fig. 2). The anastomoses were carried out in the intact left groin: an end-to-side anastomosis of the radial artery onto the common femoral artery,

one of the comitant veins and a total of three subcutaneous veins of the flap onto branches of the great saphenous vein in an end-to-end fashion. No nerve reconstruction was performed. The postoperative course was uneventful. No flap-related complications occurred. Due to a filiform stricture at the urethral anastomosis, the patient underwent open urethroplasty 10 months postoperatively. Twelve months postoperatively, the patient was able to urinate while standing. The appearance of the neo-phallus was subjectively rated as good, and the patient reported on an excellent tactile and erogenous sensitivity (Fig. 6, right column). No donor-site complications were recorded. Partial flap necrosis is reported to occur in 7–11% of phalloplasty cases.[1-3] The largest series published by Doornaert et al. showed a rate of 7.2% (23 out of 316 cases) with a higher incidence in smokers, patients who insisted on large-sized neo-phalluses, and after anastomotic revision.