Salvage of a ''free flap'' phalloplasty by distal arteriovenous fistula: Case report

Radial forearm-flap sensate free-flap phalloplasty was performed in a 32-year-old female-to-male transsexual. An arteriovenous loop was created by end-to-side anastomosis of the left greater saphenous vein to the femoral artery at the level of the femoral triangle. On the first postoperative day, the neophallus showed signs of impaired circulation, and a recent thrombus was removed from the venous pedicle. A distal fistula between the radial artery and a superficial vein was created, converting this possibly low-flow flap to a high-flow system. The flap could be salvaged entirely. Taking the well-recognized, long-term complications of arteriovenous fistulas into account, the authors do not recommend routine use of such a distal fistula. Still, in cases where Vascular patency of the venous graft is shown not to be adequate, an adjunctive arteriovenous fistula created distally may salvage the flap.