Login to Access Video or Poster Abstract: MP79-11
Sources of Funding: None

Introduction

Forearm free flaps are a well-known modality for total phallic reconstruction. Both ulnar and radial artery flaps have been described, however there is a paucity of literature comparing outcomes between these two methods.

Methods

A retrospective chart review was performed using 64 patients (65 total phalloplasties) who met inclusion criteria. All procedures were performed at our institution between 1983 and 2015. Demographics were compared using student's T-test (age) and Fisher's exact test (all other demographic variables). Outcomes were compared using Fisher's exact test to investigate for statistically significant differences in stricture rate, fistula rate and flap loss for ulnar vs. radial free flaps.

Results

Of the 65 procedures performed, there were 7 flap losses, 26 fistulas and 27 strictures. Mean follow-up was 78 months (range 0.4-395). One patient who experienced radial flap loss went on to have a successful ulnar flap neophallus created. No statistical demographical difference existed between the two groups. Of the 58 successful procedures, there was a statistically significant difference (p = <0.01) in the number of fistula formations, with ulnar flaps being superior to radial flaps. Ulnar flaps also showed a trend towards decreased stricture formation, but this failed to reach significance (p=0.059). There was no difference in the number of flap losses between the ulnar and radial groups (4 vs. 3 respectively, p=1.0).

Conclusions

Ulnar forearm free flaps are associated with a significantly decreased fistula rate when compared to radial free flaps. There was also a trend towards decreased urethral stricture rate, however this failed to reach significance. There was no difference in flap loss between the two groups.

Funding

None