Table 2. Comparison of phalloplasty techniques.
| Technique | Cosmesis | Urethra | Sensation | Donor-site morbidity | Stages |
|---|---|---|---|---|---|
| Gillies20 | Excellent | Yes | No | +++ | Multiple |
| Infraumbilical flap21 | Moderate | No | At the base | + | Single |
| Gracilis flap22 | Moderate | No | No | + | Single |
| OFF27 | Moderate | Yesa | Yes | + | 2 |
| ALT26, 28 | Good | Yesb | Yes | + | Single |
| LDF29 | Good | Yesa | Yes | ++ | Single |
| RAFF24, 25, 30, 31, 33 | Excellent | Yes | Yes | +++ | Multiple |
| RAFFU34 | Good | Yes | Yesc | + | Multiple |
Abbreviations: ALT, anterolateral thigh flaps; LDF, latissimus dorsi flap; OFF, osteocutaneous fibular flaps; RAFF, radial artery-based forearm free flap; RAFFU, radial artery-based free flap urethroplasty.
a
A prelaminated skin-graft urethroplasty can be fashioned and incorporated in the phallus. However, urethral complications can be as high as 50%.
b
A neourethra can be fashioned in a ‘tube within a tube' fashion only in patients with thin adipose layer. In patients with thick adipose layer, the ALT flap is not wide enough to be rolled in a ‘tube within a tube' fashion.
c
Sensation is present on the entire neourethra and at the base of the pedicled phalloplasty.