![Page 1: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/1.jpg)
FOREARM PHALLOPLASTY
FOR FEMALE TO MALE
GENDER CONFIRMATION
SURGERY
Richard A. Santucci, MD, FACS, HON FC Urol(SA)
Senior Surgeon, Crane Surgical Services-Austin
![Page 2: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/2.jpg)
BRIEF INTRO
I am a reconstructive urologist (18 years) who has decided to devote the rest of my career to the “Mount Everest” of transgender surgery.
Newest member Crane Surgical Services (Austin).
Formerly full professor and reconstructive urology Fellowship director at the Detroit Medical Center and newly (re)minted Texan.
Santucci 2019
2
![Page 3: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/3.jpg)
TODAY’S FORMAT
This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with
breaks) which doesn’t lend it easily to a 20 minute video. Todays talk will
summarize with slides then present necessarily too short video after.
thanks
Santucci 2019
3
![Page 4: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/4.jpg)
Step 1: WPATH (World Professional
Association for Transgender Health)
appropriate clearance for gender
confirmation surgery
Persistent, well-documented gender
dysphoria
Capacity to make a fully informed decision
and to consent for treatment
Be of the age of majority in the country of
surgery
Significant medical or mental health
concerns, if present, must be reasonably well
controlled at the time of surgery
Santucci 2019
4
![Page 5: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/5.jpg)
Step 2: (Generally)
Mastectomy/chest gender confirmation
surgery first
Then (Usually minimally invasive)
hysterectomy
Depilitate the nondominant arm or donor leg
Santucci 2019
5
![Page 6: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/6.jpg)
INCIDENCE OF TRANSGENDERISM
Probably not truly known
Estimates of up to 1/200 Americans : 1.6 million
Perhaps 25% of transgender men want surgery: maybe 1/100 have bottom surgery
Perhaps 50% of transgender women want surgery: up to 30% get bottom surgery
205,850 people (0.66%) in 18-24 age range
967,1000 (0.58%) in 25-64 age range
Santucci 2019
6
![Page 7: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/7.jpg)
![Page 8: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/8.jpg)
OUR PRACTICE HAD DONE OVER 600
PHALLOPLASTIES
IN ONE YEAR 2018 OUR PRACTICE DID:Phalloplasty- 108
Vaginoplasty-139
Top surgery-124
Penile Implants (in phalloplasty patients)-46
Metoidioplasty-24
Santucci 2019
8
![Page 9: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/9.jpg)
STEP 3: MARK THE ARM
Santucci 2019
9
![Page 10: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/10.jpg)
![Page 11: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/11.jpg)
![Page 12: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/12.jpg)
STEP 4: INCISE THE ARM, CREATING
URETHAL, PENILE, AND CORONOPLASTY
DONER PORTIONS AND PRESERVING
NERVE, VEIN AND ARTERY. TAKES HOURS Santucci 2019
12
![Page 13: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/13.jpg)
STEP 5: TUBULARIZE THE
URETHRA/PENIS, CREATE CORONA
Santucci 2019
13
![Page 14: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/14.jpg)
STEP 6: CLOSE THE ARM WITH LOCAL TISSUE
FLAPS AND THIGH STSG. COVER WITH
WOUND VAC.Santucci 2019
14
![Page 15: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/15.jpg)
STEP 7: (BUT SIMULTANEOUS)
VAGINECTOMY
Santucci 2019
15
![Page 16: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/16.jpg)
STEP 8: FREE UP THE CLITORIS,
URETHRAL LENGTHENING
Santucci 2019
16
![Page 17: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/17.jpg)
STEP 9: CLITORAL REDUCTION AND
CREATION OF NEOPALLUS BASE
Santucci 2019
17
![Page 18: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/18.jpg)
STEP 10: FIND AND EXPOSE A
CLITORAL NERVE
Santucci 2019
18
![Page 19: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/19.jpg)
STEP 11: CREATE NEOSCROTUM
Santucci 2019
19
![Page 20: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/20.jpg)
STEP 12: MICROVASCULAR ANASTOMOSIS
OF ARTERY/VEIN. CONNECT NERVE
Santucci 2019
20
![Page 21: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/21.jpg)
Voila
Santucci 2019
21
![Page 22: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/22.jpg)
QUICK INTRO TO ALTERNATE METHOD:
ANTERIOLATERAL THIGH FLAP
PHALLOPLASTY (ALT=“LEG”)Santucci 2019
22
![Page 23: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/23.jpg)
ALT
MarkMake urethra
Santucci 2019
23
Free up
pedicle
![Page 24: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/24.jpg)
ALT STEPS
Move under muscles Inset (affix) in place
Santucci 2019
24
![Page 25: Forearm Phalloplasty for Female to Male Gender Confirmation … · 2019-09-11 · my career to the “Mount Everest” of transgender surgery. Newest member Crane Surgical Services](https://reader034.vdocuments.site/reader034/viewer/2022042420/5f37bfdfbda2ae0083249416/html5/thumbnails/25.jpg)
NEOPHALLUS CAN BE MADE WITH
LATISSUM DORSI FLAP TOO IF DESIRED
Good for those who want NO visible scar.
We try to avoid this as all if its performance characteristics seems worse
than ALT (leg) or RFF (arm)
Santucci 2019
25