Falcone Marco, Preto Dr. Mirko, Ciclamini Dr. Davide, Peretti Dr. Federica, Cirigliano Dr. Lorenzo, Ferro Dr. Ilaria, Plamadeala Dr. Natalia, Ceruti Dr. Carlo, Gontero Prof. Paolo

(128) EVALUATION OF DONOR-SITE MORBIDITY AFTER RADIAL FOREARM FLAP ELEVATION FOR TOTAL PHALLIC RECONSTRUCTION IN TRANSGENDER MEN

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives Radial artery forearm free-flap (RAFFF) phalloplasty is the main technique used to total phallic construction (TPC) in transgender men. Donor-site morbidity has been rarely investigated. The study aims to evaluate the surgical and functional outcomes of donor site reconstruction. Methods It is a retrospective analysis of TPC with RAFFF performed from 2016 to 2022. Were considered as outcome measures: duration of the procedure, hospital stay, size of the donor-site defect, and postoperative complication rate. Validated tools and questionnaires used for functional outcomes evaluation were: Vancouver and POSAS scale, Scar Pinch Test, and aROM. Patient-reported outcomes were inquired using a 3 items ad-hoc created questionnaire. A subanalysis was made according to the donor site reconstruction technique: Group A a full-thickness skin graft (FTSG); Group B a single-layer dermal matrix with split-thickness skin (STSG) graft. Results Group A included 18 (53%) patients, whereas group B 16 (47%) patients. Mean follow-up was 24 months (IQR 11-40). The median donor-site defect was 302 cc (IQR 306-323, p=0.21). Early postoperative complications were described in 23.5% of cases. Mean graft take was 91%. A complete graft take was detected in 58.9% of the patients, with a significant advantage for group B (93.8%) respect to group A (27.8%) (p= 0.0001). In Group B a significantly shorter operative time (310min vs 447min p= 0.0001) and a reduced median hospital stay (8 days vs 10 days p= 0.001) were detect. Overall 80% of patients were satisfied with the appearance of the arm, and 92% with the post-surgery functionality. The analysis reveals that Group B reached a significantly higher satisfaction rate for arm appearance compared to group A (94% vs 66% p = 0.048). Conclusions FTSG or single layer dermal matrix with STSG for donor-site reconstruction after RAFFF provides satisfactory surgical, functional and aesthetic outcomes. Conflicts of Interest None to declare.

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