Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation for phalloplasty. Currently on stable gender-affirming hormone therapy (GAHT) for [X] years. Reports persistent gender dysphoria regarding external genitalia. Goals include phallic construction, urethral lengthening, and scrotoplasty. No history of pelvic surgery. BMI [X]. Tobacco/nicotine use: [Negative/Positive]. Psychosocial support system: [Stable/Limited]. WPATH SOC 8 criteria met.
Clinical Examination Findings
Genitourinary exam: Previous metoidioplasty/vaginectomy status [if applicable]. Assessment of donor site (forearm/thigh) for skin graft harvest: adequate vascularity, no significant scarring, hair density noted. Assessment of local tissue for urethral lengthening. Pelvic floor tone: [Normal/Hypertonic]. No signs of local infection or dermatological contraindications at donor or recipient sites.
Treatment Protocol
Proposed surgical plan: Staged phalloplasty including radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap. Procedures: Phallic construction, urethral lengthening (UL), scrotoplasty, and vaginectomy. Secondary stages: glansplasty, testicular prosthesis placement, and erectile device implantation. Post-operative care: strict immobilization of donor site, monitoring of flap perfusion, and prophylactic antibiotics.