Phalloplasty is the construction or reconstruction of the penis, or modification of the penis by surgery. The term phalloplasty is also sometimes used to refer to penis enlargement.
The first phalloplasty performed for the purpose of sexual assignment was performed on trans men Michael Dillon in 1946 by Dr. Harold Gillies, documented in Pagan Kennedy's book.
Video Phalloplasty
History
Russian surgeon Nikolaj Bogoraz performed the first reconstruction of a total penis using cartilage ribs in a reconstructed linga made from a tube tube flap in 1936. The first female gender assignment procedure to men was done in 1946 by Sir Harold Gillies to fellow physician Michael Dillon, and his technique remains standard for decades. Further improvement in micro surgery makes more techniques available.
Maps Phalloplasty
Indication
Complete construction or penile reconstruction may be performed in patients who:
- Has a congenital aberration such as micropenis, epispadias, and hypospadias
- Has lost his penis
- It's a trans man who wants genital change surgery as part of their gender transition.
There are four different techniques for phalloplasty. All techniques involve taking a tissue flap from a donor site and extending the urethra.
Surgery for genetic men is simpler than transgender female-to-male patients, because the urethra requires less elongation. Urethra a trans man ends near the vaginal opening and should be extended long. Uretra prolongation is where most of the complications occur.
With all types of phalloplasty in trans men, scrotoplasty can be performed by using the labia majora (vulva) to form the scrotum in which prosthetic testes can be inserted. If vaginectomy, hysterectomy and/or oophorectomy have not been performed, they can be performed at the same time.
Unlike metoidioplasty, phalloplasty requires erect prosthesis to be implanted to achieve an erection. This is usually done in a separate operation to give healing time. There are several types of erectile prostheses, including medical devices such as soft sticks that allow neo-penis to either stand or hang. Penile implants require neophallus with the appropriate length and volume to be a safe choice. The long-term success rate of implants in the penis is made lower than the success rate of reconstruction in men who are born with penises. A good sensation in the reconstructed penis may help reduce the risk of implants eventually eroding through the skin.
The previous technique used bone graft as part of the reconstruction. Long-term follow-up studies from Germany and Turkey for more than 10 years show that this reconstruction maintains its uncomplicated stiffness later in life. Unfortunately, the reconstructed penis can not become mushy anymore without damaging the internal bone graft.
Temporary elongation can also be obtained by a procedure that releases the suspensory ligament in which it attaches to the pubic bone, thereby allowing the penis to progress to the outside of the body. This procedure is done through a horizontal incision located in the pubic area where pubic hair will help hide the incision site. However, scar formation can cause the penis to pull back. Therefore, the American Urological Association "considers the division of the penis suspensory ligaments to increase penis length in adults into procedures that have not been proven safe or efficacious."
In November 2009, there was ongoing research to synthesize the corpora cavernosa (erect tissue) in the lab in rabbits for use in patients requiring penile construction surgery. Of the rabbits used in the preliminary study, 8 of 12 had a biological response to sexual stimuli similar to controls, and four impregnations were caused.
Description of technique
Flap of arm
Surgery using the forearm as a donor site is the easiest to do, but it produces an unwanted scar cosmetically on the open arm area. The arm function may be inhibited if the donor site does not heal properly. Electrolysis and/or laser hair reduction is required for relatively non-hairy neophallus.
Sometimes full-scale methotcooplasty is performed several months before the actual phalloplasty to reduce the likelihood of complications after phalloplasty. Sensation is maintained through the clitoral tissues at the base of the neophallus, and the surgeon will often try to connect the joint nerve from the clitoris or nearby. The nerves of the flap and the attached tissue can eventually connect. This does not always guarantee the ability to achieve genital orgasm after healing, because the most important task of nerve reconnection is to make sure the penis is able to feel the injury, but rarely loses the ability to orgasm..
The following explanation of this technique has much in common with other approaches, but the gland construction is different.
- Surgery begins (after the patient is prepared) with the forearm marked for the size of the graft. After the graft is taken, another graft will be used to cover the arm (producing a secondary scar).
- The graft is dissected to expose the veins and antebrachial skin nerve . (the last one done with care for reassembling later)
- If the urethra is being built at the same time as the phallus, it joins in this step. Otherwise, the gland is shaped. Sometimes glansplasty is performed in a separate surgical stage after urethral extension.
- The vein segment to the groin of the patient is "borrowed" to facilitate the incorporation of graft with pre-existing tissue.
- The veins are carefully attached to the femoral artery .
- The blood supply from the graft and vein leading to the femoral artery is joined.
- Clitoris and ligament caps are cut, and nerve bundles are isolated for now. While this assumes that the clitoral tissue is assimilated (buried) into the base of the penis, some surgeons provide the option to leave it as in a state like metoidioplasty.
- The flap is partially attached physically while the surgeon tries to join the neural bundle.
- If the urethra is extended, it now joins a catheter that will remain in place for healing purposes for two to four weeks. Otherwise, the skin will be stitched and/or the scrotum is made.
If the patient chooses to have the urethra extended to the neophallus gland, it is formed by the following steps:
- The labia minora are injected with a mixture of saline and epinephrine.
- Then split and layers separated using blunt and blunt dis- tection.
- The coating is wrapped around the catheter and stitched.
- The mucosal flap of the vagina can be used to bridge the urethra by extension. This is often done in a separate procedure. Alternative graft locations include mouth/cheeks or experimentally, intestines. If the labia minora is not used during the construction of urethral extension, (or in the presence of sufficient remaining ingredients) it can be used during glansplasty to give better results than a full-thickness skin graft.
Flap from the chest
The relatively new technique involving the flap from the breast under the armpit (known as musculocutaneous latissimus dorsi free transfer flap) is a step forward in phalloplasty. The advantages of this technique over the forearm flap technique include:
- No hair (little or no electrolysis)
- Aesthetic appearance of normally colored skin (glands may be tattooed with the right color)
- Being able to feel a tactile sensation (as with any form of phalloplasty, this does not mean the ability to have a genital orgasm after healing, since the sensitive zones are limited to the base of the penis)
- Leaving an unobtrusive scar
- Have a lower complication of both initial surgery and erectile prosthetic insertion
Unprofitable ones include:
- Using motor nerves so that erotic sensations can not be achieved, only tactile sensations.
- Can drag the nipple to the side causing it to die from its usual location.
This is a three-part operation that lasts six to nine months. The steps consist of:
The making of Neophallus uses an MLD-free flap
- The operation is started (after the patient is prepared) with the chest side marked for flap size.
- The flap is dissected to expose the vein and the thoracodorsal nerve.
- The flap, while still attached to the blood supply, is formed into a coarse lingga shape by rolling the ends together.
- The vein segment to the patient's thighs is "borrowed" to allow for easier incorporation of flaps with pre-existing tissues.
- The veins are carefully attached to the femoral artery .
- The blood supply from the flaps and veins leading to the femoral artery joins.
- The clitoris and ligaments are disconnected and the nerve bundles are isolated.
- The flap is partially attached physically while the surgeon tries to join the neural bundle.
During early recovery, neophallus is protected from contact with other tissues with special dressings designed to avoid complications of blood supply.
After three months, urethroplasty (urethral extension) is done.
- Neophallus is dissected and a buccal oral mucosa grafted into a cavity created and extended to the original urethra and joined to permanently allowing urine while standing
- The catheter is placed for several weeks to allow for proper healing
After three to six months, a device that allows an erection can be inserted.
Flap of feet
The lower leg operation is similar to the forearm with the exception that the donor scar is easily covered with socks and/or pants and is hidden from view. Other details are similar to the forearm flap, especially the need for permanent hair removal before surgery. Flap of the foot or other areas where less visible scars can be combined with a free forearm flap to create urethral elongation or to sculpt penis glans.
Close public areas
The location of the flap is around the pelvic bone, usually running across the belly below the navel. Thus, there is a large horizontal scar that may not be aesthetically acceptable. Flap has a less natural appearance and can not maintain long-term erection implants. Electrolysis is required before surgery with alternatives that cleanse the hair through shaving, or chemical remedies.
Gillies Techniques
This technique was pioneered by Sir Harold Delf Gillies as one of the first competent phalloplasty techniques. It is simply a flap of the abdominal skin that is rolled into a tube to simulate the penis, with the urethral extension being the other part of the skin to make "tubes in a tube." The initial erectile implant consists of flexible rods. Further improvement involves insertion of the abandoned blood supply supply in place to prevent tissue death before transplantation to the groin. The most recent technique involves a network with attached pedicles.
Abdominal muscle
The skin whipped muscle coverings fall from popularity. This procedure is at least 3 steps and involves implanting an expansion balloon to facilitate the amount of skin needed for grafting. Graft has a less natural appearance and tends to maintain long-term implant erection.
Subcutaneous soft silicone implants
This phalloplasty procedure involves insertion of subcutaneous silicone implants under the skin of the penis.
Surgical technique without touch
This technique for penile implantation of prosthesis is a surgical procedure developed by J. Francois Eid for implantation of penile prosthesis. Implantation through the use of the "No Touch Technique" minimizes the risk of infection.
Due to advances in the design and manufacturing process of IPP, increased infection with mechanical resistance has emerged as a major cause of implant failure. Although relatively rare (varying from 0.06% to 8.9%) infection of the penile prosthesis results in serious medical consequences for the carrier, requiring complete removal of the device and permanent loss of penis size and anatomy. Bacterial contamination of the device occurs during surgery, and this is caused by allowing direct or indirect contact of the prosthesis with the patient's skin. More than 70% of infections are formed from skin organisms including Staphylococcus epidermis, aureus, streptococcus and Candida albicans.
Traditional strategies to combat infections aim to reduce the number of skin colonies such as rubbing the skin preparations with alcohol and chlorhexidine or killing bacteria after the implant is contaminated by skin flora such as intravenous antibiotics, antibiotic irrigation and antibiotic-coated implants. The "No Touch" technique is unique in that it aims to prevent bacterial contamination from the prosthesis by completely eliminating skin contact with the device.
Coupled with antibiotic-coated implants, the "No Touch" technique reduced the infection by 0.46%, opposing the traditional method of having a 5% infection rate. The use of antibiotic-coated implants and surgical techniques without touch with skin preparation and the use of perioperative antibiotics have been found to be very important in the prevention of infection among penile implants. J. Francois Eid developed a technique without touch in 2006 on the hypothesis that removing contacts between the prosthesis and skin, either directly or indirectly through surgical instruments or gloves, should reduce the incidence of contamination of the device with the skin flora responsible for infection.
Procedures
Three days before the procedure, the patient is placed on oral fluoroquinolone, an antibacterial drug. During this time, the patient rubs the lower abdomen and genitals daily with chlorhexidine soap. On the day of surgery, Vancomycin and Gentamicin are given intravenously one to two hours before the procedure. The lower abdomen and genitals are shaved, rubbed for five minutes with a Chlorhexidine sponge and prepared with a Chorhexidine/Alcohol applicator. The area is then covered with a surgical curtain and Vi DrapeÃ,® above the genitals. Before the incision is made, the Foley catheter is inserted into the bladder through the urethra.
A 3 cm scrotum incision is made on the raphe rapper and is carried down through the subcutaneous tissue to the Buck's fascia. Retractor Scott, a flexible tool that holds open the skin of the surgical site, is applied to the area.
Up to this stage of operation, the process has been consistent with the sanitation practices associated with standard surgical sterility. In this stage of "No Touch" Technique, after the incision is made, all instruments, including surgical gloves that have touched the skin, are removed. The loose curtain is then placed throughout the surgical field and secured at the edges with adhesive strips. A small opening in the curtain is then made on top of the incision and the yellow hook is used to secure the opening edge to the incision edge, completely covering and isolating the patient's skin. At this point new instruments and equipment are replaced and the entire prosthesis is inserted through the small opening of the loose curtain. The loose curtain allows the manipulation of the penis and scrotum required for this procedure without touching the skin.
Implantation of the device continues with the incision and dilation of the corpora, the size and placement of the penis cylinder, and the placement of pumps in the scrotum and reservoir in the retropubic chamber. Saline is used throughout the implantation for irrigation. After the corporotomy is closed and all tubes and components of the prosthesis are covered with a Buck's fascia layer, the subcutaneous tissue is closed and the "No-Touch" drape is removed and the skin is closed.
Future
In the future, biotechnology can be used to make a fully functional penis.
General complications
Because phalloplasty has improved over the decades, the risks and complications of surgery have been reduced. However, there is still a need for revision surgery to correct the wrong healing.
A study of postoperative men showed that on average, 25% had one or more serious complications of neopenis. The reports consist of:
- Loss of phallus due to disease or blood supply problem
- Cephalic vein thrombosis (blood clot)
- Ischemia artery (lack of blood supply)
- Infection
- Unlimited distal necrosis (death of the penis)
- Hematoma (bruises)
In the same study, the likelihood of complications from the urethra was extended higher, averaging 55%. The most common complications reported are:
- Urine fistulas (holes) that require perineal urethrostomy
- Urine fistula (hole) with conservative care
- Urine retention (from new urethral stenosis or narrowing)
- (Erection) changes in prosthesis (from complications)
- (Erection) prosthesis explantation (removal of prosthesis without replacement)
There is also the possibility of fat embolism "linked to liposuction and autologous fat transfer, a procedure in which liposuction fat is injected back into the face of the same patient, breast, buttock or penis."
See also
- List of transgender related topics
- Penis enlargement
- Penis transplant
- Sex change operation
References
Source
External links
- FemaletoMale.org | Information about Phalloplasty
- Video: Minimally Implasive Penile Surgery to improve erectile dysfunction
- Technique without touch
Source of the article : Wikipedia
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