Evaluation of the role of pedicled gracilis muscle flap in decreasing the incidence of urinary fistula after free radial forearm flap phalloplasty / Galal Mohamed Elshorbagi ; Supervised Shreif Abdelrahman , Amr Fayad , Mohammed Abdelrassoul

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Urology

A tube-in-tube design of the flap facilitates voiding in a standing position. Further research is required to identify an ideal reconstructive technique that would guarantee superior cosmetic and functional results, minimizing donor site morbidity. (Graffa et al., 2014) However, there are many disadvantages associated with RFFF such as, donor-site morbidity, a conspicuous large scar area on the forearm and penile color mismatch. Donor-site morbidity is estimated to arise more frequently after RFFF phalloplasty than other RFFF-based reconstructions because of the larger flap size, which is approximately as large as two thirds of the forearms{u2019} circumference. (Wouter et al., 2017) However, the radial forearm flap, such as other forms of phalloplasties with urethroplasties, is accompanied by high rates of fistula formation and urological complications. Fistula rates vary widely among surgeons, with some studies reporting rates as low as 14% and others as high as 64%.The anastomosis of the neourethra and native lengthened urethra is most susceptible to fistulas. Factors contributing to fistula development following phalloplasty include infection, insufficient soft tissue at the urethral anastomosis, and compromised blood supply secondary to a scarred tissue bed

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