Sophia Hu, Erik Reiche Echandi, Raphael Kim, Michael Parisi, Devin O’Brien-Coon
Introduction: Radial forearm free flap phalloplasty is a procedure that creates a penis in transgender patients. Sensory recovery in the neophallus and donor site is crucial towards optimizing outcomes, but limited quantitative data on this exists. We prospectively quantified sensory outcomes in the neophallus and donor site using the Pressure Specified Sensory Device (PSSD) in 14 patients for up to 1.6 years.
Neophallus: Sensation was tested circumferentially and lengthwise along the neophallus. Amongst patients with at least two follow-up visits, the majority (6/8, 75%) regained sensation in their neophallus at an average of 85 days post-operatively. Amongst the six circumferential regions of the neophallus, the right ventral and right lateral aspects of the penis had significantly greater sensation over time.
Forearm donor site: Sensation was tested on the thumb, index finger, and first dorsal webspace. Mixed effects regression analysis with random intercepts did not yield significant differences in two-point sensation over time, but one-point sensation in the thumb and webspace were significantly worse in patients at over 1 year follow-up.
Conclusions: Neophallus sensory recovery can be accomplished with little significant change in forearm sensation. Future studies with a larger patient cohort and patient-reported outcomes are necessary to fully characterize recovery.
Radial forearm free flap phalloplasty is a complex procedure that uses skin from the forearm to create a penis in transgender patients. The ability for the new penis (neophallus) and donor site to regain sensation is important for patient outcomes. We studied return of sensation in these areas in 14 patients for up to 1.6 years.
Neophallus: Sensation was measured circumferentially and lengthwise on the neophallus. Of patients seen more than once, most (6/8, 75%) regained neophallus sensation about 85 days after surgery. The right aspects of the penis had significantly more sensation over time.
Forearm donor site: Sensation was measured in the thumb, index finger, and space between them. There were no significant differences in the ability to feel two separate points close together, but after a year, there was significantly worsening ability to feel sensation at a single point on the thumb and space between fingers.
Conclusion: Patients can regain feeling in the neophallus without significant change in forearm sensation. More research with more patients is needed to further understand this.