Figure 3.

Anterolateral thigh (ALT) flap hair removal. An alternative source for well-vascularized skin for phalloplasty with or without urethral lengthening is the ALT. The anatomic landmarks for an ALT-flap are the anterior superior iliac spine (A, cephalad), and the lateral aspect of the patella (C, distal). An imaginary line is drawn between these two points (AC), and the exact halfway-point is marked (B). The flap is supported via muscle perforators from the descending branch of the lateral circumflex femoral artery that usually perforates the vastus lateralis muscle. The most cephalad perforator usually lies within a 3-cm area of point B. The flap dimensions can be exactly the same as for a radial artery forearm flap. The longer urethral segment (unmarked) can be medial or lateral to the wider segment used to construct the phallus.