Phalloplasty in transsexuals is a complicated matter because of the different qualities of the tissue which have to be imitated. Many different surgical techniques have been tried *(5), which are all far away from the natural penis. Especially the stiffening by vasoconstricition and vasodilatation and the imitation of the glans are problems which canīt be solved in the foreseeable future. The lenghthening of the urethra is combined with a high complication rate. Nevertheless two techniques have been developed, which are optical and functionally good enough to cause most of the German female-to-male-transsexuals (FTM) decide to undergo the surgical treatment of phalloplasty. This review concentrates on the description of these two techniques respectively the special techniques of the three surgeons / centres the German FTMs prefer:
1. Phalloplasty by transplantation of a free radial forearm flap, especially the techniques of Biemer (Munich) and Daverio (Lausanne, Switzerland).
2. Phalloplasty with a downturned rectus muscle, bilateral groin flaps and a semirigid silicone rod stiffener. (All tissue is nourished by its original vessels. The scars are inconspicuous.) This technique has been developed and is performed by Exner (Frankfurt).
Among the German FTMs a local accumulated preferance of certain surgeons is conspicious. At many transsexuals the decision seems to depend more on the recommendations of the transsexual friends in the local self-help-group for a certain surgeon than on practical aspects of the respective technique (place and conspiciousness of the scars, place of exit of the urethra / ability to void while standing, long-term reliability of the stiffening implant etc.). The transsexuals should be informed better and more objectively about all possibilities to prevent disappointment after the operation. This review shall contribute to this aim.
Key words
transsexualism - gender reassignment surgery - female to male - phalloplasty - penis - free flaps - lengthening of the urethra - metaidoioplasty
According to the restriction to German matters this text is only written in German. Descriptions of the techniques in English are available (see literature *(1), (2), (4)).
