{"doi":"10.1016/j.jsxm.2019.02.010","title":"Flap Combination Phalloplasty in Female-to-Male Transsexuals","abstract":"<jats:title>ABSTRACT</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>Although phalloplasty with a free radial forearm (RF) flap is the gold standard for sex reassignment surgery in female-to-male transsexuals, it can result in unsightly scars, lymphedema, and numbness of the hand.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Aim</jats:title>\n                  <jats:p>To introduce the concept of flap combination phalloplasty and its clinical application.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>This is a retrospective chart review study of patients undergoing phalloplasty using various multiple flaps. Demographic data, surgical data, and outcomes were recorded.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes</jats:title>\n                  <jats:p>Of the 15 cases, 5 were urethral fistulas; 4 were venous thrombosis; 2 were urethral calculus; and 1 was a partial flap loss.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>15 patients were included (age range 25–43 years, median 34 years). An RF flap and a deep inferior epigastric artery perforator flap combination were most frequently used. The median operative time for flap combination phalloplasty was 10.5 hours (range 6.5–12.5 hours). There was no total flap necrosis, but there was 1 case of partial flap loss. There were urethral fistulas in 5, venous thrombosis in 4, and urethral calculus in 2 cases.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications</jats:title>\n                  <jats:p>Flap combination phalloplasty will become the third option when both the RF flap and the anterolateral thigh pedicle flap are not useful.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Strength &amp; limitations</jats:title>\n                  <jats:p>Flap combination phalloplasty is a complex operative procedure with a prolonged operative time, but it can provide more flap selection and reduce the morbidity at each donor site. Choosing from many different options can be beneficial to patients.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion</jats:title>\n                  <jats:p>Flap combination phalloplasty has a similar complication rate to other procedures and has advantages in terms of flexibility and less donor site morbidity; it may thus be an option when either the RF flap or the anterolateral thigh pedicle flap cannot be used.</jats:p>\n               </jats:sec>","journal":"The Journal of Sexual Medicine","year":2019,"id":687399,"datarank":0.515098080672772,"base_score":3.4339872044851463,"endowment":3.4339872044851463,"self_citation_contribution":0.515098080672772,"citation_network_contribution":0.0,"self_endowment_contribution":0.515098080672772,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":30,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":119883,"name":"Toshiyuki Watanabe","orcid":null,"position":1,"is_corresponding":false},{"id":1600791,"name":"Yoshihiro Kimata","orcid":null,"position":2,"is_corresponding":false},{"id":1795780,"name":"Yuzaburo Namba","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Flap Combination Phalloplasty in Female-to-Male Transsexuals","abstract":"<jats:title>ABSTRACT</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>Although phalloplasty with a free radial forearm (RF) flap is the gold standard for sex reassignment surgery in female-to-male transsexuals, it can result in unsightly scars, lymphedema, and numbness of the hand.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Aim</jats:title>\n                  <jats:p>To introduce the concept of flap combination phalloplasty and its clinical application.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>This is a retrospective chart review study of patients undergoing phalloplasty using various multiple flaps. Demographic data, surgical data, and outcomes were recorded.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes</jats:title>\n                  <jats:p>Of the 15 cases, 5 were urethral fistulas; 4 were venous thrombosis; 2 were urethral calculus; and 1 was a partial flap loss.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>15 patients were included (age range 25–43 years, median 34 years). An RF flap and a deep inferior epigastric artery perforator flap combination were most frequently used. The median operative time for flap combination phalloplasty was 10.5 hours (range 6.5–12.5 hours). There was no total flap necrosis, but there was 1 case of partial flap loss. There were urethral fistulas in 5, venous thrombosis in 4, and urethral calculus in 2 cases.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications</jats:title>\n                  <jats:p>Flap combination phalloplasty will become the third option when both the RF flap and the anterolateral thigh pedicle flap are not useful.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Strength &amp; limitations</jats:title>\n                  <jats:p>Flap combination phalloplasty is a complex operative procedure with a prolonged operative time, but it can provide more flap selection and reduce the morbidity at each donor site. Choosing from many different options can be beneficial to patients.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion</jats:title>\n                  <jats:p>Flap combination phalloplasty has a similar complication rate to other procedures and has advantages in terms of flexibility and less donor site morbidity; it may thus be an option when either the RF flap or the anterolateral thigh pedicle flap cannot be used.</jats:p>\n               </jats:sec>","is_dataset_classified":null,"base_score":3.4339872044851463,"endowment":3.4339872044851463,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"30894300","pmcid":null,"openalex_id":"https://openalex.org/W2922514623","authors":[],"funders":[],"total_grants":0,"fwci":4.7962,"citation_percentile":0.95560351,"influential_citations":0,"citation_trend":[{"year":2020,"count":6},{"year":2021,"count":11},{"year":2022,"count":6},{"year":2023,"count":4},{"year":2024,"count":2},{"year":2025,"count":1}],"oa_status":"closed","license":"https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model","oa_locations":[{"url":"https://api.elsevier.com/content/article/PII:S1743609519304126?httpAccept=text/xml","host_type":"publisher"},{"url":"https://api.elsevier.com/content/article/PII:S1743609519304126?httpAccept=text/plain","host_type":"publisher"},{"url":"https://academic.oup.com/jsm/article-pdf/16/6/934/48477182/jsm_16_6_934.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1016/j.jsxm.2019.02.010","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/30894300","host_type":"repository"}],"fields_of_study":["Reconstructive Surgery and Microvascular Techniques","Organ and Tissue Transplantation Research","Sexual function and dysfunction studies"],"mesh_terms":["Adult","Cicatrix","Female","Humans","Male","Penis","Postoperative Complications","Retrospective Studies","Surgical Flaps","Thigh","Transsexualism","Urethral Diseases","Urinary Fistula","Sex Reassignment Surgery","Gender-Affirming Surgery"],"keywords":["Phalloplasty","Medicine","Surgery","Sex reassignment surgery (male-to-female)","Female to male","Lymphedema","Thrombosis","Penis","Thigh","Retrospective cohort study","General surgery","Cancer","Male to female","Internal medicine","Sex Reassignment Surgery","Female-to-male Transsexual","Flap Combination Phalloplasty","Single Flap Phalloplasty"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-18T21:55:03.461347Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}