Novel combined graft technique in female-to-male reconstructive surgery
Tuesday, 28 October 2008 - Urethral reconstruction is the most difficult part in sex reassignment surgery in female transsexuals and it poses many challenges. Bizic M. and colleagues from Belgrade presented during the abstract session at the recently held 4th EAU South Eastern European Meeting (SEEM) a technique wherein they combined labia minora flap and buccal mucosa graft in lengthening the urethra in female transsexuals.
Bizic’s study, which won the first prize Richard Wolf Award for best abstract, was conducted in Belgrade between June 2005 and January 2008, involving 38 patients (aged from 19 to 56 years) who underwent female to male surgery. Clitoris was lengthened by dividing both clitoral ligaments dorsally and short urethral plate ventrally. Buccal mucosa graft was quilted to the ventral side of the corpora cavernosa between the native urethral orifice and the tip of the glans.
Labia minora flap was dissected from its inner surface and anastomozed to the buccal mucosa graft performing the urethral reconstruction. All suture lines were covered by the well-vascularised subcutaneous tissue which originated from the labia minora. Neophallic skin reconstruction was performed using available clitoral and labial skin.
The mean follow-up was 21 months (6 months to 3 years). Small penis was created from hypertrophied clitoris with good functional and aesthetic results in 34 patients. Neourethra ranged from 9.4 – 14.2 cm (mean 11.7cm). Dribbling and spraying were noticed in 12 cases and solved spontaneously. There were one urethral stricture and three fistulas that required secondary minor revision.
In their study, the researchers concluded that combined buccal mucosa graft and labia minora flap represent a good choice in urethral reconstruction in female to male transsexuals with low complication rate compared to previously reported techniques.
Source: Bizic B., Majstorovic M., Kojovic V., et al..School of Medicine, University of Belgrade, Dept. of Urology, Belgrade, Abstract Session, 1st Prize Richard Wolf Award, Abstract 78, “Urethral lengthening in female transsexuals by combined buccal mucosa graft and labia minora flap,” EAU 4th South Eastern European Meeting, Tirana, Albania, 17-18 October 2008.
