April 18, 2013
The first study of long-term effects of radial forearm flap phalloplasty was published just this month. The aesthetics, functionality, and health status of the donor site on the forearm was examined. This study was reported by researchers at the Center for Sexology and Gender Problems at Ghent University Hospital in Belgium.
Does “radial forearm flap phalloplasty” sound like gibberish? Let’s break it down. Phalloplasty is one of the genital procedures available for trans men (the other is metoidioplasty, which we’ve previously covered). In a phalloplasty, tissue from elsewhere on the body is used to make a penis. ”Radial forearm” refers to the part of the body used: a section of forearm, including blood vessels and nerves. “Flap” means the tissue from the forearm is removed completely from the body then put on in another location. “Flap” is in contrast to “pedicle”, where the tissue remains connected in one spot. So a radial forearm flap phalloplasty, essentially, is where tissue from the forearm is used to make a penis. At the same time, hysterectomy and bilateral oophorectomy are done.
As with any surgery involving a graft, both the donor and receiver tissues are damaged. This procedure leaves a scar on the forearm where The researchers report that scarring, reduced bone density, limited range of motion, decreased finger/hand strength, loss of graft, delayed healing, and sensory changes have all been reported. But how common are they? Enter the current research.
Who participated in this research? 44 trans men who had had the procedure. They were an average of 9 years post-surgery, with a range from 9 months to 22 years. Six had a metoidioplasty before their phalloplasty. The median age at surgery was 28. All participants were on hormone therapy, and had been for an average of 10 years; most on a mix of testosterone esters delivered intramuscularly (which is fairly standard practice). The trans male participants were compared to a control group of cis women. There was no weight difference (BMI) between the two groups, but there were more tobacco smokers in the experimental (trans men) group than in the control group (cis women). The control group was not on any metabolic or hormonal altering treatment. In addition to general questions (e.g., tobacco use, medications, medical conditions), the forearm scars of participants were assessed. Questions relating to scar pain, stiffness, and sensation were included. Bone density and body mass were also measured.