Massachusetts Chapter of the American College of Surgeons

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Complication Profiles of Pedicled Thigh and Free Cutaneous Flaps in Gender Affirming Phalloplasty
Miguel I. Dorante, MD, MBE1, Michael M. Jonczyk, MD, MS1, Sachin Vallamkonda, BS2, Nicholas C. Bene, MD1, Brian B. Freniere, MD1
1Lahey Hospital and Medical Center, Burlington, MA; 2Tufts University Medical School, Boston, MA

Background: Gender affirmation surgery (GAS) has been shown to be crucial for some individuals with gender dysphoria. In particular, phalloplasty can allow for standing micturition, penetrative sexual intercourse with preserved erogenous sensation, and an aesthetically acceptable phallus. Little is reported on the outcomes of various published techniques of phalloplasty. This retrospective study aims to illustrate the clinical outcomes and complication profiles related to different flap choices in gender affirming phalloplasty.
Methods: Using the NSQIP database from 2010 to 2020, a retrospective cohort analysis was performed using patients with ICD codes related to a clinical diagnosis of gender dysphoria (Table 1). We identified associated procedural codes for two commonly performed principal techniques: pedicled thigh flap (pTF) and free cutaneous flap (fCF) phalloplasty. The Welch two sample t-test and Chi-square test were used for data analysis.
Results: 43 pTF and 30 fCF were performed for gender affirming phalloplasty between 2010 to 2020. There were no significant differences in patient demographics (Table 2). When compared to pTF, the fCF phalloplasty was associated with longer operative times, longer length of stay, and higher RVU per case (Table 3). Regarding complications, patients who underwent fCF phalloplasty had a higher incidence of hematologic complication and transfusion requirement.
Conclusion: Multiple techniques, including pTF and fCF, can be used for phalloplasty in gender affirmation surgery. Our study suggests that there are similar complication profiles for pTF and fCF phalloplasty. However, the latter may be associated with longer operative time and length of stay but a higher reimbursement rate.


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