Phalloplasty aims to construct a functional and aesthetic phallus in transgender and gender diverse and cisgender patients with absence or loss of penile tissue. Sensation is a critical outcome in postoperative quality of life, impacting placement of erectile devices, sexual function, and overall well-being. Despite this, there is currently a lack of consensus on strategies to optimize sensation in phalloplasty.
View Article and Find Full Text PDFJ Plast Reconstr Aesthet Surg
January 2025
The long thoracic nerve's (LTN) superficial location on the chest wall renders it vulnerable to iatrogenic injury. Plastic surgeons' gender-affirming mastectomy volumes are rapidly increasing. This operation involves lateral chest contouring placing the distal LTN at risk of injury along the chest wall.
View Article and Find Full Text PDFBackground: The deep inferior epigastric perforator (DIEP) flap is the standard of care in autologous breast reconstruction. The superficial inferior epigastric artery perforator flap (SIEA) is an alternative reconstructive option, with the compromise of less donor-site morbidity but variable perfusion to subscarpal fat zones. Fat necrosis is a known complication from marginal perfusion variability.
View Article and Find Full Text PDFCurr Opin Urol
September 2024
Purpose Of Review: To review findings related to phantom genital sensation, emphasizing phantom sensation in the transgender and gender diverse (TGD) population. We discuss prevalence, presentation and potential implications for sensory outcomes in genital gender-affirming surgery.
Recent Findings: There is a high prevalence of phantom genital sensations in the TGD population.
Gender-affirming vaginoplasty (GAV) comprises the construction of a vulva and a neovaginal canal. Although technical nuances of vulvar construction vary between surgeons, vulvar construction is always performed using the homologous penile and scrotal tissues to construct the corresponding vulvar structures. Therefore, the main differentiating factor across gender-affirming vaginoplasty techniques is the tissue that is utilized to construct the neovaginal canal.
View Article and Find Full Text PDFObjective: Despite politically charged media coverage and legislation surrounding gender affirming care (GAC), many organizations have released position statements to provide scientifically backed clinical practice standards, combat misinformation, and inform medicolegal policies. The purpose of this study is to objectively assess the availability and the content of the official position statements of relevant medical professional organizations regarding GAC.
Summary Background Data: A list of U.
Background And Objective: The vulva is the external portion of a gender-affirming vaginoplasty or vulvoplasty procedure-the "visible" result of surgery. The vulvar appearance can play a major role in how individuals feel about their surgical results and new genital anatomy. Therefore, optimizing the aesthetics of the vulva is an important component of surgical care.
View Article and Find Full Text PDFJ Plast Reconstr Aesthet Surg
March 2024
Gender-affirming phalloplasty involves flap tubularization, placing unique stresses on the vascularity of the flap. Tubularization renders the flap susceptible to postoperative edema that can lead to excessive turgor that, if left untreated, can compromise perfusion and threaten the viability of the phallic reconstruction. This phenomenon has not been formally described in our literature.
View Article and Find Full Text PDFContext/objective: To assess short-term changes in health outcomes in people with cervical-level spinal cord injury (SCI) who underwent upper extremity (UE) reconstruction via either novel nerve transfer (NT) or traditional tendon transfer (TT) surgery with individuals who did not undergo UE surgical reconstruction.
Design: Prospective, comparative cohort pilot study.
Participants: 34 participants with cervical SCI met the following inclusion criteria: age 18 or older, greater than 6 months post-injury, and mid-cervical level SCI American Spinal Injury Association Impairment Scale (AIS) A, B or C.
Plast Reconstr Surg Glob Open
January 2024
Symptomatic neuromas of the superficial radial nerve (SRN) can cause debilitating pain. Traditional surgical management options have demonstrated inconsistent outcomes prompting a search for alternatives. Recent reports have emerged on the use of targeted muscle reinnervation (TMR) for neuromas of the SRN using donors that are well established in hand surgery, such as the brachioradialis (BR) or extensor capri radialis longus or brevis.
View Article and Find Full Text PDFObjective: To present 2 clitoroplasty techniques-the preputial skin and urethral flap-and describe our rationale for using each technique to construct the clitoro-urethral complex in gender-affirming vaginoplasty.
Methods: For uncircumcised patients or circumcised patients with greater than 2 cm of inner preputial skin and at least 8 cm of shaft skin proximal to the circumcision scar, we use the preputial skin clitoroplasty, a modification of the Ghent style clitoroplasty. The entire corona is used after medial glans and urethral mucosa is excised.
Resident physicians take annual in-service examinations (ISEs) as part of continuing medical education, which set educational priorities, allow for formative feedback, and guide preparation for final board examinations. Gender-affirming care is provided in many specialties but has been an underrepresented area in medical education. Plastic surgeons provide a large portion of gender-affirming surgical care.
View Article and Find Full Text PDFSensate flaps are increasingly used in diverse areas of plastic surgery. Concurrently, modern techniques in neuroma prevention have emerged, such as regenerative peripheral nerve interface (RPNI). Despite increasing use of sensate flaps, the combined use of donor-site neuroma prevention techniques has yet to be described.
View Article and Find Full Text PDFBackground: The rate of opioid prescribing after low-risk surgical procedures has increased over the past decade, and surgeons are responsible for prescribing approximately one-third of all opioid medications. There is additional supporting evidence that patients only consume about half of the opioids prescribed to them after outpatient plastic surgery. Currently, there is no literature to provide surgeons with reference ranges for how much opioid medication will adequately provide analgesia for patients after undergoing bilateral breast augmentation (BBA) surgery.
View Article and Find Full Text PDFUnlabelled: A key component of success of a nerve transfer is the innervation density, which is directly affected by the donor nerve axonal density and donor-to-recipient (D:R) axon ratio. Optimal D:R axon ratio for a nerve transfer is quoted at 0.7:1 or greater.
View Article and Find Full Text PDFBreast cancer can affect anyone; therefore, it affects people of all gender identities. Reconstructive options after breast cancer must then address the needs of all people. Our institution is unique in its provision of both high-level comprehensive breast and gender affirmation care.
View Article and Find Full Text PDFIntroduction: It is frequently quoted in mainstream media that the clitoris has "8000 nerve endings." However, no study has yet quantified the number of nerve fibers (axons) innervating the human clitoris. The dorsal nerves of the clitoris (DNCs) are the primary source of sensation and somatic clitoral innervation.
View Article and Find Full Text PDFAnterior interosseous nerve to ulnar motor nerve supercharged end-to-side (SETS) nerve transfer to restore intrinsic function is a recently adopted nerve transfer in severe ulnar neuropathy. Its success is predicated on the critical threshold number of axons innervating the intrinsic muscles. Given the relative expendability of the abductor digiti minimi (ADM) muscle and the critical function of the other intrinsic muscles, the authors modified their SETS transfer to redirect axons from the ADM to turbocharge the ulnar motor nerve to innervate the more critical intrinsic muscles.
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