The aim of this study was to present our latest modified protocol on neophallus construction that we have applied in 32 female-to-male transsexuals. The applied protocol consisted of neourethra prelamination with split skin thickness grafting at the lateral donor lower leg, and neophallus construction after 6 months with the free, prelaminated, and sensate osteofasciocutaneous fibular flap, followed by urethro-urethral anastomosis. Because of initial difficulties on harvesting and positioning the fibular flap, we had 2 total and 4 partial necrosis. Ten patients had a urethral stricture, and 7 a fistula. In 6 patients a stricture expansion was required and in 5 closure of the fistula was needed. The donor-site morbidity was moderate. In conclusion, in our series this protocol proved to be the method of choice in this very demanding field of genitalia reconstructive surgery, offering an essential improvement of the quality of life of transsexual patients.
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