[11] The flap width and the need for double-bending of the flap, however, are not altered. Additionally, most patients do not accept an additional scar on the dorsal, most visible part of the neo-phallus. Another possibility to reduce the necessary flap width and double-bending consists of neo-urethra-prelamination with STSG, FTSG, or vaginal mucosa.[3, 8, 9, 12] The partial flap necrosis rate of prelaminated neo-urethra varies in most case series. A significantly lower rate in partial flap necrosis, however, does not clearly appear in the ICG-001 purchase literature review. Küntscher and Hartmann reported no occurrence in 15 cases of RFF phalloplasties with prelaminated urethra

(FTSG).[9] In contrast, Schaff and Papadopulos presented

a large case series of phalloplasties with prelaminated urethra (vaginal mucosa or STSG) with a partial flap necrosis-rate of 16% (5 out of 31 cases) in free fibular flaps and 16.6% (1 out of 6 cases) in free RFF.[8] Fang et al. compared the traditional tube-in-tube flap and the free RFF with a prelaminated urethra (vaginal mucosa). Partial flap necrosis occurred in 6 out of 28 patients (21%) in the traditional flap group, while none was found in the PD0325901 nmr 28 patients of the prelaminated group.[3] In a recent study, Song et al. reported on 3 partial flap necrosis (15.8%) of their 19 free osteocutaneous RFF with prelaminated urethra (FTSG).[12] The literature review of urological complication shows a high incidence of strictures and fistulas. The benefits of urethra prelamination have not been clearly demonstrated. Fang et al. reported strictures in 14% (4 out of 28 cases)

and urethrocutaneous fistulas in 79% (22 out of 28 cases) of patients after the classic tube-in-tube design. With prelaminated urethra, strictures occurred in 11% (3 out of 28 cases) and urethrocutaneous fistulas in 57% (16 out of 28 cases). All the fistulas occurred at the junction between the pars fixa and the pars pendulans of the neo-urethra and no fistulas were observed in vaginal mucosa prefabricated penile neo-urethra.[3] With the classic tube-in-tube free RFF, Doornaert et al. reported on urological complications in 40% of their patients (127 out of 316 cases). Fistulas were detected in 25% (80 out of 316 see more cases), strictures in 6% (20 out of 316 cases), and a combination of both in 8.5% (27 out of 316 cases). Spontaneous healing occurred in 66% (53 out of 80 cases) of the fistulas, while 42.5% (54 out of 127 cases) of the patients with urological problems needed further surgical procedures to obtain urethral function.[2] Küntscher and Hartmann found an incidence of 53% out 15 cases for fistulas at the urethra-anastomosis in their series of free RFF with a FTSG-prelaminated urethra.[9] Using a FTSG for prelamination of a osteocutaneous-free RFF in 19 phalloplasties, Song et al.