Penile (Re)Construction with the Radial Forearm Free Flap

Abstract

The radial forearm free flap provides a relatively thin, potentially sensate, minimally hair-bearing septocutaneous flap with reliable anatomy and enough flexibility that it can be fashioned into a construct resembling a penis. The tube-within-a-tube design incorporates a centrally placed vascularized neourethra with a distal extension that gets folded over to create a semblance of a neoglans. Although this design eliminates any distal meatal stenosis, proximal urethral stenosis and fistulae continue to be the most frequent complication, especially in transgender men. An unsightly donor site scar is the primary disadvantage of the radial forearm free flap phalloplasty.