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Recipient Vessels in Phalloplasty: A Systematic Review
James Gaston BA, R'ay Fodor BASc, Antonio Rampazzo, MD PhD, Michele Fascelli, MD PhD, Bahar Bassiri Gharb, MD, PhD
Plastic Surgery Department, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195
2025-01-10
Presenter: James Gaston
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The submitter is a medical student and contributed to study design, initial search, article screening, data collection, interpretation, manuscript preparation, and revisions.
Director Name: Bahar Bassiri Gharb, MD, PhD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Selection of recipient vessels in phalloplasty is challenging due to the absence of adequate vessels in the immediate proximity. There is no consensus on the appropriate vessel selection. We hypothesize that the selection of recipient vessels in phalloplasty impacts complications and flap survival.
Methods
A literature search following PRISMA guidelines across Ovid-MEDLINE/PubMed, Embase, and CENTRAL databases yielded 45 included articles. Collected data included demographics, surgical details, donor and recipient vessels, use of interpositional grafts, number of venous anastomoses, and outcomes. Statistical analysis used pooled proportions with a random-effects model.
Results
The included articles represented 1,967 patients who underwent phalloplasty procedures, with 1,585 gender-affirming cases (80.6%). Radial forearm free-flap was used in 999 cases (50.8%), while the deep inferior epigastric artery (DIEA) was used in 1,409 cases (71.6%). The remaining 28.4% of cases used the femoral artery or a branch, with approximately a quarter incorporating an interpositional vein graft. Overall, arterial and venous anastomotic complications occurred in 2.1% and 2.4% of cases, respectively. The use of an interpositional vein graft with the femoral artery resulted in significantly higher arterial anastomotic complications at 16.3% compared to 0.1% for the femoral artery without a vein graft (p<0.001) and 1.1% for the DIEA without a vein graft (p<0.001).
Conclusions
The choice of recipient vessels plays an important role in phalloplasty success. Deep inferior epigastric vessels exhibit the lowest proportion of vascular complications. However, the significantly higher complications observed with the femoral artery may be attributable to the use of an interpositional vein graft.
