INTRODUCTION: This study aims at comparing outcomes of anterolateral thigh (ALT) flap phalloplasty and of radial forearm flap (RFF) phalloplasty. ALT flap phalloplasty is gaining increasing popularity in gender confirming surgery. This is the largest series comparing ALT flap Phalloplasty and RFF phalloplasty.
MATERIALS and METHODS: Four-undred-thirteen phalloplasties were performed at a single institution between 2004 and 2016 (320 RFF, 93 ALT). Flap survival, urinary complications (fistulae and strictures), outcomes of erectile and testicular implants, number of secondary procedures required at the penis and at the donor site. PROMs were evaluated as well by administering a questionnaire to investigate QoL and aesthetic outcomes. Mean follow up was 51 months in the RFF group and 40 months in the ALT group.
RESULTS: Rates of secondary procedures in the penis (45 vs15 %)and in the donor site (16 vs5 %) were significantly higher in the ALT group compared to the RFF group. In the RFF group there were significantly higher early fistula rates (31.6 vs 15.2 %) and significantly higher rates of patients wearing an implant (65.6 vs 42 %). No statistically significant differences were foung in the rates of fistulas requiring surgery, stricture rates, flap revision rates and prosthesis-related complications rates. Even PROMs (responders: 37 RFF and 17 ALT patients) showed showed no statistically significant difference.
CONCLUSION: There seems to be no significant differences in terms of outcomes when comparing ALT phalloplasty is a valuable alternative to RFF phalloplasty that allows to avoid the forearm scar. As a result, ALT phalloplasty can be considered an effective alternative to RFF phalloplasty for those patients who want to avoid the forearm scar and accept higher chances of secondary procedure to improve the penis and the donor site.