Early Penile and Donor Site Sensory Outcomes After Innervated Radial Forearm Free Flap Phalloplasty: A Pilot Prospective Study

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-09-06 DOI:10.1002/micr.31228

Sophia Hu, Norah Oles, Erik Reiche, Raphael Kim, Wilmina Landford, Lauren Eisenbeis, Melissa Noyes, Calvin R. Schuster, Michael Parisi, Siti Rahmayanti, Vance Soares, A. Lee Dellon, Devin Coon

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引用次数: 0

Abstract

Background

Radial forearm free flap phalloplasty (RFFF) is a set of complex reconstructive procedures aimed at creating an aesthetic and functional penis in transgender patients. Sensory recovery in the neophallus and donor site is crucial for optimizing outcomes, but the few prior studies that exist assess neophallus sensation at limited locations and time points. The purpose of this study was to prospectively quantify sensory outcomes in the neophallus and donor site following RFFF phalloplasty.

Methods

Sensation testing occurred prospectively over February 2019–January 2021 on Stage 1 RFFF phalloplasty patients using the Pressure Specified Sensory Device (PSSD). On the neophallus, one-point discrimination (1PS) pressure threshold and lengthwise sensory recovery were measured at six circumferential locations proximally to distally. On the donor site, 1PS was measured at three locations on the donor hand.

Results

Nineteen patients were included (average age 34.0 years old, range 18–53 years). Among patients that received neophallus testing (n = 13), eight had at least two follow-up appointments. Six of these patients had sensation as of their most recent measurement (75.0%), with an average of 73 days to regain sensation. There was a significantly greater proportion of patients with sensation at the right ventral (80.0% after 3 months vs. 11.1%–60.0% before 3 months, p = 0.024) and right lateral (100.0% after 3 months vs. 11.1%–60.0% before 3 months, p = 0.004) aspects of the neophallus over time. Pressure required to elicit sensation decreased by 18.0% from 1 week–1 month postoperatively to 3–7.7 months postoperatively in the right ventral neophallus (96.2 g/mm² ± 11.3 g/mm² to 56.6 ± 39.9 g/mm², p = 0.037). Among patients that received donor site testing (n = 11), mixed effects regression analysis with random intercepts demonstrated significant changes in the thumb (3.4 g/mm² ± 1.4 g/mm², p < 0.05) and webspace (13.5 g/mm² ± 4.9 g/mm², p < 0.01) that returned to baseline at 3 months postoperatively (1.7 g/mm² ± 1.0 g/mm², p > 0.05, and 2.3 g/mm² ± 4.0 g/mm², p > 0.05, respectively).

Conclusion

This pilot study demonstrates that quantitative sensory testing can be used to monitor post-phalloplasty sensory changes. Recovery was significantly associated with contralateral (i.e, right side in a left forearm RFF) aspects of the neophallus, suggesting a possible pattern of circumferential sensory innervation via RFFF sensory nerves. Future studies with a larger sample size and longer follow-ups are necessary to fully characterize sensory recovery in phalloplasty patients.

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神经支配前臂桡侧游离瓣阴茎成形术后的早期阴茎和供体部位感觉效果：一项试点前瞻性研究

背景：前臂桡侧游离皮瓣阴茎成形术（RFFF）是一套复杂的重建手术，旨在为变性患者打造美观且功能正常的阴茎。新阴茎和供体部位的感觉恢复对于优化疗效至关重要，但之前的少数研究仅在有限的位置和时间点评估了新阴茎的感觉。本研究旨在前瞻性地量化 RFFF 阴茎整形术后新阴茎和供体部位的感觉结果：在 2019 年 2 月至 2021 年 1 月期间，使用压力指定感觉装置（PSSD）对第一阶段 RFFF 阴茎整形术患者进行了前瞻性感觉测试。在新阴茎上，从近端到远端六个圆周位置测量了单点辨别（1PS）压力阈值和长度方向的感觉恢复。在供体部位，在供体手掌的三个位置测量了1PS：共纳入 19 名患者（平均年龄 34.0 岁，18-53 岁不等）。在接受阴茎海绵体检测的患者（13 人）中，有 8 人至少接受了两次复诊。其中 6 名患者在最近一次测量时有感觉（75.0%），平均 73 天恢复感觉。随着时间的推移，右侧腹侧（3 个月后为 80.0%，3 个月前为 11.1%-60.0%，p = 0.024）和右侧外侧（3 个月后为 100.0%，3 个月前为 11.1%-60.0%，p = 0.004）有感觉的患者比例明显增加。右侧阴茎腹侧引起感觉所需的压力从术后 1 周-1 个月到术后 3-7.7 个月下降了 18.0%（96.2 g/mm2 ± 11.3 g/mm2 到 56.6 ± 39.9 g/mm2，p = 0.037）。在接受供体部位检测的患者中（n = 11），随机截距的混合效应回归分析表明拇指的变化显著（分别为 3.4 g/mm2 ± 1.4 g/mm2、p 2 ± 4.9 g/mm2、p 2 ± 1.0 g/mm2，p > 0.05，以及 2.3 g/mm2 ± 4.0 g/mm2，p > 0.05）：这项试验性研究表明，定量感觉测试可用于监测阴道成形术后的感觉变化。恢复情况与新阴茎的对侧（即左前臂RFF的右侧）明显相关，这表明可能存在通过RFFF感觉神经进行周向感觉支配的模式。未来有必要进行样本量更大、随访时间更长的研究，以全面了解阴茎整形术患者感觉恢复的特点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.