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ALT Phalloplasty

Combined ALT/Forearm Phalloplasty

Combined ALT/Forearm Phalloplasty

Combined ALT/Forearm Phalloplasty

Source: Kamol Hospital

Combined ALT/Forearm Phalloplasty, aka Composite Phalloplasty, is a variant of the ALT Phalloplasty procedure which uses a pedicled thigh donor flap to create the phallus, plus a small forearm graft to create the neo-urethra. In experienced hands, one-stage pedicled ALT phalloplasty combined with RFF urethral reconstruction is a feasible alternative surgical option in eligible transgender men, who desire a less conspicuous forearm scar.

Advantages of the procedure:

  • The urethra can be created during initial operation;
  • Only a straight scar line on the forearm;  
  • Lower risk of urethral stricture;
  • Lower risk of flap failure and necrosis with pedicled technique.

Possible drawbacks comprise flap-related complications, difficult inner flap monitoring and urethral complications.

Staging of Surgeries

Stage 1: Top Surgery, Hysterectomy, Vaginectomy, Primary Urethral Lengthening, Electrolysis/Laser Hair Removal of thigh and forearm.

Stage 2: Phalloplasty, Urethroplasty, Glansplasty, Scrotoplasty. Thigh is covered with split thickness skin graft.

Stage 3: Testicular Implants, Penile Implant.

Surgeons Who Offer Combined ALT/Forearm Phalloplasty

Journal Articles

Flap Combination Phalloplasty in Female-to-Male Transsexuals.
Namba Y, Watanabe T, Kimata Y. J Sex Med. 2019 Jun;16(6):934-941. doi: 10.1016/j.jsxm.2019.02.010.
Although phalloplasty with a free radial forearm (RF) flap is the gold standard for sex reassignment surgery in female-to-male transsexuals, it can result in unsightly scars, lymphedema, and numbness of the hand. This is a retrospective chart review study of patients undergoing phalloplasty using various multiple flaps. Flap combination phalloplasty has a similar complication rate to other procedures and has advantages in terms of flexibility and less donor site morbidity; it may thus be an option when either the RF flap or the anterolateral thigh pedicle flap cannot be used.

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction. [FULL TEXT]
van der Sluis WB, et. al. Microsurgery. 2017 Nov;37(8):917-923.
Between January 2008 and December 2015, nineteen transgender men (median age 37, range 21-57) underwent pedicled ALT phalloplasty combined with RFFF urethral reconstruction in one stage. The size of the ALT flaps ranged from 12 × 12 to 15 × 13 cm, the size of the RFFFs from 14 × 3 to 17 × 3 cm. Total RFFF failure occurred in two patients, total ALT flap failure in one patient, and partial necrosis of the ALT flap in one patient. Long-term urinary complications occurred in 10 (53%) patients, of which 9 concerned urethral strictures.

 

Last updated: 06/24/20



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