Urethral Reconstruction Using the Radial Forearm Free Flap: Experience in Oncologic Cases and Gender Reassignment  Jörg Dabernig, Odhran P. Shelley, Guiseppe Cuccia, Jürgen Schaff  European Urology  Volume 52, Issue 2, Pages 547-554 (August 2007) DOI: 10.1016/j.eururo.2007.01.004 Copyright © 2007 Terms and Conditions

Fig. 1 The empty penile skin envelope following subcutaneous penectomy. The preserved penis skin is of good quality, and sensate. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions

Fig. 2 Secondary urethral reconstruction in a transgender patient. Previous local flaps used to reconstruct urethra failed leaving a perineal urethral opening. The tubed radial forearm flap for urethral reconstruction is shown prior to insertion into a tunnel within the neo-phallus. Recipient vessels prepared through a right groin crease incision. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions

Fig. 3 Flap outlined on the left forearm. The central strip will be tubed for urethral reconstruction. Skin distally (at wrist) is planned for glans reconstruction in this patient. The stippled skin is included and then de-epithelialised to provide an augmentation effect. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions

Fig. 4 The radial forearm flap tubed in-situ to form a neo-urethra, with glans distally. The fascia is sutured seperately around the neo-urethra to provide a “waterproofing” layer. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions

Fig. 5 Radial forearm flap tubed to neo-urethra and harvested completely. The radial forearm free flap is ready for microanastomosis; the prepared vessels can be seen clearly. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions

Fig. 6 Prepared phallus before inserting the radial forearm free flap. A tissue holder is used for pulling the flap from distal to proximal. The proximal base incision can be seen; this is the area where the proximal neo-urethra should be positioned for urethral anastomosis. Groin vessels are prepared and saved with sloops. A previous testicle reconstruction with implant was also done. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions

Fig. 7 Semierect positioning after successful microanastomosis. The reconstructed glans is pink, a sign for well-vascularised free-flap tissue. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions

Fig. 8 Follow-up after successful neo-urethra reconstruction after tumour ablation. The penis is of a good size with good tissue augmentation. The radial forearm free flap donor site is covered with a full-thickness skin graft, harvested from the left groin. European Urology 2007 52, 547-554DOI: (10.1016/j.eururo.2007.01.004) Copyright © 2007 Terms and Conditions