RU2234258C2 - Method for prosthetics of neophallus - Google Patents

Abstract

FIELD: medicine, plastic surgery.

SUBSTANCE: one should perform phalloplasty out of either thoracodorsal or radial fragment, create canals in neophallus to implant there vascular prostheses and phalloprosthesis' cylinders and suture blindly their distal part and fix proximal one to periosteum of pubic bones. Pumps of prosthesis should be placed into patient's scrotum. Moreover, as phalloprosthesis one should apply vascular ones to be implanted in 2-3 mo through incision in area of patient's penis "root". In 2-3 mo vascular prostheses should be opened to implant there semirigid phalloprostheses.

EFFECT: higher cosmetic effect and decreased postoperational complications.

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Description

The invention relates to medicine, in particular to plastic surgery, and may find application in prosthetics of neophallus.

Penile reconstruction is a complex problem of plastic surgery. Total phalloplasty is usually performed in patients with severe trauma to the penis, after penectomy due to the tumor process, with congenital genital pathology, as well as in the case of transsexualism. The purpose of this operation is to create a “functional” neophallus, which can be used both for normal (standing) urination and for sexual intercourse.

For phalloplasty, tubularized muscle-skin flaps (radiation, thoracodorsal) are mainly used. To simulate erections, semi-rigid or inflatable prostheses are usually implanted in neofallos. Superficial sensitivity is achieved by microsurgical anastomosis of the superficial nerves of neophallus with n. ilioingvinalis, n. genitofemoralis or n. dorsalis clitoris.

For the first time, the male penis was restored after its traumatic loss through a five-stage operation, including the creation of a Filatov round stem from the skin of the anterolateral surface of the abdomen, stem migration and the subsequent formation of neourethra from the scrotum skin [1].

Describes the creation of neophallus in three stages using an abdominal tubular flap, which was raised as a “cricket bat”, and then a teflon rod was inserted into it [1].

Phalloplasty using a free inguinal flap has been described [1].

A known method of phalloplasty with simultaneous stem urethroplasty from the forearm flap based on the radial artery with the simultaneous introduction of autologous cartilage from the rib [1].

A known method of phalloplasty with bone support by using a flap with a shin in combination with a fragment of the fibula [1].

There is a method of prosthetics of neofallos, including implantation of semi-rigid prostheses in neofallos with their preliminary immersion in a vascular prosthesis from dacron to simulate cavernous bodies and fixation of the prosthesis to the pubic joint [1].

A common disadvantage of these known methods is their low efficiency and a large number of complications in the form of rejection and inflammatory reactions.

Closest to the proposed method is neofallos prosthetics, including the formation of neofallos from a thoracodorsal or radial flap, phalloendoprosthesis is performed 10-12 months after phalloplasty by creating channels in the neophallus and implantation of the neophallus cylinders, the distal part is blindly sutured, and the proximal bones [2]. This method uses flexible silicone prostheses or various types of AMS inflatable prostheses coated with a fragment of a fluorlavsan vascular prosthesis or a fragment of a Gore-Tex prosthesis, and the prosthesis pump is placed in the formed scrotum instead of one of the testicular endoprostheses.

The disadvantage of this method is the relatively low cosmetic effect and complications associated with tissue necrosis or migration of the prosthesis.

The objective of the invention is a method for prosthetics of neophallus, which minimizes postoperative complications associated with the development of periprosthetic infection or skin erosion over the prosthesis, leading to inflammation and transplant rejection, and to increase the cosmetic effect.

The problem is solved by the method, which consists in the fact that 2-3 months after phalloplasty with a beam or thoracodorsal flap in the neofallos create channels and vascular endoprostheses are implanted in place of the absent cavernous bodies. The distal part is sutured, and the proximal part is fixed to the periosteum of the pubic bones. After 2-3 months of outpatient treatment, the vascular prostheses are opened through the incision in the neophyllos “root” region and semi-rigid penile prostheses are implanted in them, the vascular prostheses are sutured tightly, during the implantation of inflatable implants, their cylinders are inserted into the vascular prostheses opened in the proximal part, which are then sutured around the connectors with the pump, the tank is placed in the prebubble space or behind the rectus abdominis muscle, the pump is placed in the scrotum, the skin over the dentures is sutured tightly.

Clinical observation: Patient T., 24 years old, was admitted to the clinic in November 2001 for prosthetics of neophallus. From the anamnesis it is known that in 1994 he suffered an electric injury with damage to the skin of the abdomen, the area of the womb and buttocks. In the city hospital at the place of residence, the patient had an amputation of the penis, but the scrotum was saved. Subsequently, in the City Clinical Hospital No. 71 of Moscow in 1994, the patient underwent phalloplasty with a radiation graft with the simultaneous formation of neourethra.

At the first stage, channels were created on the lateral sides of the patient in the neofallos body using bougie. Then, vascular prostheses were implanted in them, the distal part of which was sutured tightly, and the proximal part was fixed to the periosteum of the pubic bones. The postoperative period was satisfactory, inflammation or suppuration in the long-term postoperative period was not observed. Three months later, at the second stage, the patient underwent implantation of an AMS inflatable prosthesis. His cylinders were inserted into vascular prostheses, a reservoir was implanted in the retia, and the pump was placed in the scrotum. The postoperative period was uneventful without signs of periprosthetic infection. A good aesthetic and functional result was obtained.

List of references

1. Milanov I.O., Adamyan R.T., Kozlov G.I. Correction of sex with transsexualism, pp. 67-113.

2. Tan Hui-Meng. Penile prosthesis implantation in a transsexual neophallus Asian J Androl 2000 Dec; 2: 304-306 (prototype).

Claims (1)

A method for prosthetics of neophallus, including phalloplasty from a thoracodorsal or radial flap, creating channels in the neophallus, implanting vascular prostheses and phalloprosthesis cylinders in them, blindly suturing their distal part and fixing the proximal to the periosteum of the pubic bones, placing the prosthesis pump in the scrotum, as phalloendoprostheses, vascular endoprostheses are used, which are implanted after 2-3 months through an incision in the "root" of the penis, after 2-3 months, the vascular prostheses are opened and they are implanted with semi-rigid penile prostheses.