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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