Total Phallic Reconstruction Using Radial Artery Based Forearm Free Flap Phalloplasty in Patients with Epispadias-Exstrophy Complex

Purpose: We report our experience with total phallic construction using the radial artery forearm free flap in patients with bladder/cloacal exstrophy and micropenis-epispadias complex. Materials and Methods: We retrospectively reviewed notes on the 16 patients with bladder/cloacal exstrophy and micropenis-epispadias complex treated with total phallic construction using the radial artery based forearm free flap between January 2003 and October 2013. Surgical outcome, phallic cosmesis, complications, eventual need for revision surgery and patient satisfaction were recorded during followup. Results: This technique allowed reconstruction of a cosmetically acceptable phallus in 15 patients. In 1 patient the distal third of the phallus was lost due to acute thrombosis of the arterial anastomosis immediately postoperatively. At a median followup of 20.5 months (range 2 to 38) 15 patients (93%) were fully satisfied with phallic cosmesis and size. Urethral stricture and fistula were the most common complications, which developed only at the native neourethral anastomosis. They were successfully managed by revision surgery. After revision surgery 11 of the 12 patients who underwent penile prosthesis implantation achieved sexual intercourse. Conclusions: The radial artery based forearm free flap is a good technique for total phallic construction in patients with bladder/cloacal exstrophy and micropenis-epispadias complex, providing reliable cosmetic and functional results.