Citation
Rifkin WJ, Daar DA, Cripps CN, Mars G, Zhao LC, Levine JP, Bluebond-Langner R. Gender-affirming Phalloplasty: A Postoperative Protocol for Success. Plast Reconstr Surg Glob Open. 2022 Jun 20;10(6):e4394. doi: 10.1097/GOX.0000000000004394. PMID: 35747259; PMCID: PMC9208864.
Abstract
Increased access to care and insurance coverage has led to an increase in gender-affirming surgeries performed in the United States. Gender-affirming phalloplasty has a variety of donor sites and surgical techniques including both pedicled and free flaps. Although surgical techniques and patient outcomes are well-described, no reports in the literature specifically discuss postoperative management, which plays a crucial role in the success of these operations. Here, we present a postoperative protocol based on our institution's experience with gender-affirming phalloplasty with the hope it will serve as a standardized, reproducible reference for centers looking to offer these procedures. Patients undergoing gender-affirming phalloplasty at our institution followed a standardized protocol from the preoperative stage through phases of postoperative recovery. Medication, laboratory, physical and occupational therapy, flap monitoring, and dressing change guidelines were extracted and compiled into a single resource detailing the postoperative protocol in full. Our institution's standardized postoperative protocol for gender-affirming phalloplasty is detailed, focusing on flap monitoring, mobilization and activity, medications, and postoperative dressing care. One hundred thirty first-stage phalloplasty procedures were performed between May 2017 and December 2021, with two patients (1.5%) experiencing partial necrosis and one incidence (0.8%) of total flap loss. For optimal and safe surgical outcomes, the surgical and extended care teams need to understand flap monitoring as well as specific postoperative protocols. A systematic approach focusing on flap monitoring, mobilization and activity, medications, and postoperative dressing care decreases errors, accelerates recovery, shortens length of stay, and instills confidence in the patient.
Key Points
- Published in Plastic and reconstructive surgery. Global open in 2022.
- Indexed in PubMed as PMID 35747259.
- Mapped to Gender-Affirming Surgery, Outcomes, Methods & Education.
- Abstract available from PubMed and rendered as static text on this page.
Clinical Relevance
This publication supports a focused body of work on gender-affirming surgery, including patient-centered outcomes, robotic peritoneal flap vaginoplasty, complications, revisions, and measurement of surgical quality.