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Page 6 of 15 Hontscharuk et al. Plast Aesthet Res 2020;7:65 I http://dx.doi.org/10.20517/2347-9264.2020.124

Figure 5. Preoperative markings for phalloplasty using a SCIAP flap for urethral reconstruction combined with an anterolateral thigh
flap. SCIAP: superficial circumflex iliac artery perforator

Potential advantages of the MLD flap include its reliable vascular pedicle, large surface area, and
minimal donor site morbidity. Proponents note maintenance of flap bulk which may enhance retention
of subsequent prosthetic devices [40,41] . Overall, 93.8% of patients report being satisfied with their phallus
[7]
[40]
following surgery . The primary disadvantage of the MLD flap was the lack of orgasmic sensibility . A
literature review reported sensory function in 17 patients, yet 100% of patients reported tactile sensation
[7]
following the procedure . No studies examining erogenous sensation have been published.
The osteocutaneous fibula flap (OCFF) was first described in 1993 as a phalloplasty option to achieve
[7]
neophallic rigidity without the use of a prosthesis . The flap is based on the peroneal artery and may be
harvested with the sural nerves [7,42] . The sural (or short saphenous) nerve arises from the medial sural
cutaneous nerve between the two head of the gastrocnemius muscle. It travels superficial to the muscle
until the middle of the leg, where it joins the sural communicating branch of the common fibular nerve. It
then travels to the lateral malleolus, providing sensory innervation of the posterior-lateral leg [43,44] . Tactile
and erogenous sensation have been reported following OCFF phalloplasty [7,42] , and patients reported feeling
[42]
“good to very good” with sexual intercourse following this procedure .

The superficial circumflex iliac artery perforator flap (SCIAP), often used in conjunction with other flaps,
is another option for phalloplasty procedures [Figure 5] [45-47] . The SCIAP flap is based on perforating vessels
from the superficial circumflex iliac artery, a branch of the external iliac/superficial femoral artery. It is
[48]
not commonly used as a sensate flap in phalloplasty procedures. However, Iida et al. describe the use of
a sensate SCIAP flap in head and neck reconstruction using the lateral cutaneous branch of an intercostal
nerve. Potential advantages of this flap include a concealed donor site, minimal donor-site morbidity, and
the ability to thin the flap at the time of harvest [48,49] .