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Background:. The radial forearm free flap is frequently chosen for phalloplasty; however, flap size required for phalloplasty is associated with a large scar burden and functional concerns. We sought to investigate donor site functionality, aesthetics, and volume deficits in a cohort of individuals who underwent radial forearm phalloplasty (RFP) with donor site skin grafting alone or dermal substitute and subsequent skin grafting. Methods:. Donor site functionality was assessed using the quick Disabilities of Arm, Shoulder, and Hand (qDASH). Patient- and clinician-reported aesthetics were assessed using the Patient and Observer Scar Assessment Scale (POSAS). An Artec Leo three-dimensional scanner was used to measure volumetric differences from the donor site forearm and contralateral forearm. Results:. Fifteen patients who underwent RFP agreed to participate. No statistically significant differences were identified between different donor site closure methods regarding qDASH, patient-reported POSAS, or total volumetric deficits. A blinded clinician reported that POSAS approached significance at 4.7 for biodegradable temporizing matrix (BTM), 4.2 for Integra, and 3.0 for split-thickness skin graft (P = 0.05). No statistically significant differences were identified regarding distal, middle, or proximal volume deficits; however, a trend was observed regarding total volumetric deficits with BTM experiencing the lowest deficit (10.3 cm3) and skin graft experiencing the highest deficit (21.5 cm3, P = 0.82). Conclusions:. The addition of dermal matrix (BTM or Integra) to the treatment algorithm for RFP did not show statistically significant improvement in donor site volume deficits, patient-reported scar appearance (POSAS), or functionality (qDASH).

Background:. NovoSorb biodegradable temporizing matrix (BTM) is a novel, bilayer, synthetic skin substitute made of biodegradable polyurethane foam covered with a sealing membrane. BTM has demonstrated excellent outcomes in burn literature; however, few studies have been published for hand and extremity soft tissue reconstruction. Methods:. All patients who underwent extremity reconstruction with BTM from 2018 to 2023 were reviewed. Demographics, presentations, and clinical outcomes were recorded. Results:. A total of 86 cases from 54 patients (53.7% pediatric; age range: 0–81 years) were included. Common indications included trauma (36%), infection (18.6%), and malignancy (11.6%). BTM was placed over exposed tendon (38.4%), bone (19%), joints (12.8%), nerves (8.1%), and/or blood vessels (7%). BTM served as temporary wound coverage in 26 cases. Complications included hematoma (8.1%), infection (4.7%), and spontaneous delamination (4.7%). Wound closure was successfully obtained without flap use in 93.3%. Poor BTM take was associated with peripheral vascular disease, hypertension, immunosuppression, and BTM hematoma and infection (

Introduction and objective: Erectile function is an important goal for many patients post-phalloplasty. Our objective is to demonstrate a technique for placement of a single-cylinder inflatable penile prosthesis (IPP) in patients with a neophallus. Surgical procedure: IPP placement is performed 1-2 years post-phalloplasty for optimal return of sensation and vascularization. The patient voids preoperatively. Since the bladder is emptied immediately before surgery, we opt not to place a catheter in the potentially tortuous urethra and place the reservoir as early as possible to avoid significant bladder filling, which decreases the risk of bladder injury. Cefazolin and Gentamicin are administered preoperatively and a low concentration Chlorhexidine Gluconate solution is used for irrigation. An infrapubic incision is made and dissection is carried down to the pubic symphysis. The reservoir is placed in the midline prevesical space. Sharp dissection is used to develop a space in the dorsal midline of the neophallus opposite the neourethra, which is palpable without a catheter, prior to sequential distal dilation. After measuring proximally and distally, the appropriately sized device is selected and modified with a shortened, blunted tip and proximal synthetic graft. Previously placed 3–0 FiberWire anchoring sutures on the pubic bone are secured to the proximal aspect of the device. The device is then inflated to facilitate placement into the dilated space distally before tying down the sutures. Pump placement proceeds contralateral to the vascular pedicle in the most dependent aspect of the neoscrotum. Once the tubing is connected, device cycling is performed to ensure proper placement and functioning. Results: Patients are discharged the same day with the device 60% inflated. Sexual activity may occur as early as 8 weeks postoperatively. Complications are seen in up to 40% of patients. Conclusion: Continued improvements in devices and techniques are necessary to decrease complications and improve surgical outcomes as more patients pursue IPP placement post-phalloplasty.