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Article

Functionality and Scar Evaluation of the Donor Site in Extended Radial Forearm Flap Phalloplasty: How Affected Is the Arm in Day-to-Day Life? †

by
Mahmut Ozturk
1,2,3,‡,
Sascha Wellenbrock
1,2,3,*,‡,
Philipp Wiebringhaus
1,2,3,
Marie-Luise Aitzetmüller-Klietz
1,2,3,
Lara Küenzlen
4,
Anna Burger
5,
Sahra Nasim
6,
Tobias Hirsch
1,2,3,
Matthias Aitzetmüller-Klietz
1,2,3,
Baksan Tav
1,2,3 and
Ulrich M. Rieger
4
1
Department of Plastic Surgery, Center for Transgender Health, University Hospital Muenster, 48149 Muenster, Germany
2
Department of Plastic and Reconstructive Surgery, Institute for Musculoskeletal Medicine, 48143 Muenster, Germany
3
Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
4
Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Academic Teaching Hospital of the Goethe University, 60431 Frankfurt am Main, Germany
5
Department of Plastic Surgery, University Hospital Zurich, Rämistr. 100, 8091 Zurich, Switzerland
6
Department of Plastic Surgery, Alfred Krupp Hospital, Hellweg 100, 45276 Essen, Germany
*
Author to whom correspondence should be addressed.
†
The work was presented at the 50th Annual Meeting of the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC), Hamburg, Germany, 26–28 September 2019.
‡
These authors contributed equally to this work and share first authorship.
J. Clin. Med. 2024, 13(19), 6004; https://doi.org/10.3390/jcm13196004
Submission received: 2 September 2024 / Revised: 16 September 2024 / Accepted: 26 September 2024 / Published: 9 October 2024
(This article belongs to the Special Issue Recent Advances in Reconstructive Urology and Prosthetic Surgery)
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Abstract

Background: The radial forearm flap remains the gold standard in phalloplasty in gender-affirming surgery due to its versatility and functional outcome, but the significant donor site morbidity and its impact on daily functioning and aesthetic perception remains understudied. This study provides valuable insights into the mid-term functional and aesthetic outcomes of the forearm in transgender individuals following radial forearm flap phalloplasty using widespread instruments for assessment scoring systems and for the evaluation of postoperative wound healing of surgical interventions in general. Methods: Between January 2013 and March 2018, a total of 47 patients underwent radial phalloplasty at AGAPLESION Markus Hospital, and 20 consented to participate in this cross-sectional, retrospective study evaluating functional and aesthetic outcomes post-radial forearm flap phalloplasty using standardized questionnaires (DASH, POSAS, and SBSES). A univariate median regression of each score was performed to determine the associations with selected variables, and correlation analyses between scores was performed using a nonparametric Spearman rank correlation. Results: Among the 20 participants, the median Quick DASH, DASH functionality, DASH sport and music, and DASH work scores indicated minimal to no functional impairment. Scar evaluations using the PSAS, OSAS, and SBSES scales showed overall patient satisfaction with minimal concerns regarding pigmentation and scar texture. Notably, an increase of 0.27 cm2 in wound surface area added one point to the DASH sport and music score (p = 0.037). Statistical analysis also demonstrated a significant correlation between functional and aesthetic assessment scores. Conclusions: The radial forearm phalloplasty donor site, evaluated by the PSAS, OSAS, and SBSES scales, leads to minimal or no functional impairment; however, the worsening of the DASH sport and music score with increasing wound surface reflects a direct relation between wound size and functional impairment.
Keywords: genital masculinization; radial forearm free flap; gender-affirming surgery; phalloplasty; donor site morbidity genital masculinization; radial forearm free flap; gender-affirming surgery; phalloplasty; donor site morbidity

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MDPI and ACS Style

Ozturk, M.; Wellenbrock, S.; Wiebringhaus, P.; Aitzetmüller-Klietz, M.-L.; Küenzlen, L.; Burger, A.; Nasim, S.; Hirsch, T.; Aitzetmüller-Klietz, M.; Tav, B.; et al. Functionality and Scar Evaluation of the Donor Site in Extended Radial Forearm Flap Phalloplasty: How Affected Is the Arm in Day-to-Day Life? J. Clin. Med. 2024, 13, 6004. https://doi.org/10.3390/jcm13196004

AMA Style

Ozturk M, Wellenbrock S, Wiebringhaus P, Aitzetmüller-Klietz M-L, Küenzlen L, Burger A, Nasim S, Hirsch T, Aitzetmüller-Klietz M, Tav B, et al. Functionality and Scar Evaluation of the Donor Site in Extended Radial Forearm Flap Phalloplasty: How Affected Is the Arm in Day-to-Day Life? Journal of Clinical Medicine. 2024; 13(19):6004. https://doi.org/10.3390/jcm13196004

Chicago/Turabian Style

Ozturk, Mahmut, Sascha Wellenbrock, Philipp Wiebringhaus, Marie-Luise Aitzetmüller-Klietz, Lara Küenzlen, Anna Burger, Sahra Nasim, Tobias Hirsch, Matthias Aitzetmüller-Klietz, Baksan Tav, and et al. 2024. "Functionality and Scar Evaluation of the Donor Site in Extended Radial Forearm Flap Phalloplasty: How Affected Is the Arm in Day-to-Day Life?" Journal of Clinical Medicine 13, no. 19: 6004. https://doi.org/10.3390/jcm13196004

APA Style

Ozturk, M., Wellenbrock, S., Wiebringhaus, P., Aitzetmüller-Klietz, M.-L., Küenzlen, L., Burger, A., Nasim, S., Hirsch, T., Aitzetmüller-Klietz, M., Tav, B., & Rieger, U. M. (2024). Functionality and Scar Evaluation of the Donor Site in Extended Radial Forearm Flap Phalloplasty: How Affected Is the Arm in Day-to-Day Life? Journal of Clinical Medicine, 13(19), 6004. https://doi.org/10.3390/jcm13196004

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