Use of the Superficial Circumflex Iliac Artery Perforator Flap for Urethra and/or Shaft Reconstruction in Gender-Diverse Persons: 10-Year Single-Center Experience.

Background: Although the free radial forearm flap (FRFF) is the standard for phalloplasty, the conspicuous donor-site scar, need for microsurgery, and tendency for the phallus to deflate over time leads both patients and surgeons to seek alternatives. The authors describe their long-term experience with the pedicled superficial circumflex iliac artery (SCIP) flap for urethral or penile shaft reconstruction, or both. This flap can be applied for similar indications as FRFF phalloplasty, but with primary closure of the donor sites and without microsurgery.

Methods: The authors retrospectively reviewed surgical outcomes of all patients who underwent urethra or shaft reconstruction, or both, using SCIP flaps as part of phalloplasty for gender-affirming surgery in their center between 2012 and 2022.

Results: Over a 10-year period, 55 SCIP flaps were performed as part of phalloplasty. This included 47 unilateral SCIP flaps, 10 of which were used for shaft reconstructions and 37 for urethra reconstructions. Primary closure was achieved in 100% of patients. No failures were observed for shaft reconstructions. For urethra reconstructions, 8 SCIP urethras (14%) failed completely, and 3 SCIP flaps were converted to free flaps. In total, 82% of patients with a SCIP urethra reconstruction were able to stand while voiding. Eight bilateral SCIP flaps were performed for 1-stage shaft and urethra creation; among these, 3 patients (38%) experienced urethral fistulas or strictures.

Conclusions: This study shows that the SCIP flap is a technically feasible and safe pedicled alternative for urethral and penile shaft reconstruction in gender-diverse individuals, with similar urethral complication rates compared with FRFF and anterolateral thigh flap phalloplasty, but with potentially lower shaft sensation.

Clinical question/level of evidence: Therapeutic, IV.