Page 667 - Read Online

Cylinder et al. Plast Aesthet Res 2020;7:58 Plastic and
DOI: 10.20517/2347-9264.2020.85 Aesthetic Research

Systematic Review Open Access

Partial flap loss in transgender phalloplasty using
the anterolateral thigh or forearm - a systematic

literature review

Isabel Cylinder , Aaron Heston , Breanna Jedrzejewski , Zbigniew Sikora , Blair Peters , Jens Urs Berli 2
2
1
1
3
1
1 School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
2 Division of Plastic Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
3 Division of Plastic and Reconstructive Surgery, Washington University School of Medicine in St. Louis, MO 63110, USA.
Correspondence to: Dr. Jens Urs Berli, Division of Plastic Surgery, Oregon Health & Science University, 3303 SW Bond Avenue,
Portland, OR 97239, United States. E-mail: berli@ohsu.edu
How to cite this article: Cylinder I, Heston A, Jedrzejewski B, Sikora Z, Peters B, Berli JU. Partial flap loss in transgender
phalloplasty using the anterolateral thigh or forearm - a systematic literature review. Plast Aesthet Res 2020;7:58.
http://dx.doi.org/10.20517/2347-9264.2020.85
Received: 20 Apr 2020 First Decision: 18 May 2020 Revised: 23 May 2020 Accepted: 19 Jun 2020 Published: 24 Oct 2020

Academic Editor: Marlon E. Buncamper, Stan J. Monstrey Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: In this study, we systematically review the current literature regarding partial flap loss (PFL) for the two most
commonly performed types of phalloplasty, the radial forearm and the anterolateral thigh flaps. The primary
purpose is to synthesize the available information to clarify anatomic location, etiology, extent of flap loss, and
management thereof. Second, we utilize this information to inform strategies to mitigate the risk of PFL.

Methods: A systematic review of all abstracts published on phalloplasty on PubMed was performed. Abstracts
were reviewed by two senior authors who included all studies discussing flap-related outcomes after radial
forearm free flap (RFFF) phalloplasty or anterolateral thigh flap (ALT) phalloplasty for the treatment of gender
dysphoria. Primary variables collected include: flap type, PFL rate, anatomic location, extent of and management
of PFL.

Results: A total of 17 papers that reported on RFFF and/or ALT phalloplasty were included. A total of 780 RFFF
and 182 ALT phalloplasties were identified. The PFL rate was 4.5% and 7.1% respectively. Only 4/17 papers
commented on the anatomic location of PFL; none commented on the exact extent of PFL and only 4/17
commented on the management of PFL.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.parjournal.net