Partial flap loss in transgender phalloplasty using the anterolateral thigh or forearm - a systematic literature review

Aim: In this study, we systematically review the current literature regarding partial flap loss (PFL) for the two most commonly performed types of phalloplasty, the radial forearm and the anterolateral thigh flaps. The primary purpose is to synthesize the available information to clarify anatomic location, etiology, extent of flap loss, and management thereof. Second, we utilize this information to inform strategies to mitigate the risk of PFL. Methods: A systematic review of all abstracts published on phalloplasty on PubMed was performed. Abstracts were reviewed by two senior authors who included all studies discussing flap-related outcomes after radial forearm free flap (RFFF) phalloplasty or anterolateral thigh flap (ALT) phalloplasty for the treatment of gender dysphoria. Primary variables collected include: flap type, PFL rate, anatomic location, extent of and management of PFL. Results: A total of 17 papers that reported on RFFF and/or ALT phalloplasty were included. A total of 780 RFFF and 182 ALT phalloplasties were identified. The PFL rate was 4.5% and 7.1% respectively. Only 4/17 papers commented on the anatomic location of PFL; none commented on the exact extent of PFL and only 4/17 commented on the management of PFL.