[Microsurgical penile reconstruction in case of intersexuality and after penis carcinoma]. / Mikrochirurgische Penisrekonstruktion bei Intersexualität und nach Peniskarzinom.

BACKGROUND: The goals of penile reconstruction and phalloplasty include aesthetics as natural as possible and the ability of patients to void while standing and to have sexual intercourse. This article presents two more rare indications and techniques, the phalloplasty using free radial forearm flapin case of intersexuality and after penectomy due to penis carcinoma. PATIENTS AND METHODS: In transsexual individuals numerous phalloplasties in Gottlieb and Levine`s technique, by means phalloplasty of free radial forearm-flap of the non-dominant forearm, were performed in our department over the last few years. However, this technique also has its significance for phalloplasty in non-transgender persons.Two patients are considered in detail with regard to indication and surgical technique and were followed up in a multimodal setting.Patient 1 is genetically male, thirty-five years old with a micropenis in the case of pseudohermaphroditism masculine and androgen resistance.Patient 2 is a fifty-one-year old genetically male and as a result of a penis carcinoma his penis had to be amputated at the level of penis root. After absence of recurrence for 1,5 years, the penile reconstruction took place after complete resection of the remaining residual penile stump and corpora cavernosa. Both patients underwent multimodal follow-up 15 months postoperatively with regard to phalloplasty sensors and donor-site restrictions. RESULTS: An aesthetic and functional acceptable result could be obtained for both patients. Both patients are able to void while standing. The multimodal follow-up 15 months postoperatively revealed relevant differences in the sensory findings of both patients, which are due to the different anatomy of reinnervation. CONCLUSION: In microsurgical experienced departments, the technique of A. radialis phalloplasty can also be used successfully in more rare indications, as shown here, a satisfying result can be achieved in terms of function and aesthetics. The complications shown here do not differ from those using phalloplasty in transgender persons.

[Plastic surgical management in lower extremity sarcoma reconstruction]. / Plastisch-chirurgisches Management bei Weichgewebesarkomen an der unteren Extremität.

Tumors in the lower extremity with a critical size of over 5 cm diameter should principally be tested for being malignant soft-tissue sarcomas. If a soft-tissue sarcoma is present, radical oncological resection with sufficiently wide surgical margins is the most important cornerstone of curative therapy. No neoadjuvant or adjuvant treatment (radiotherapy or chemotherapy) can replace this treatment approach. Modern techniques of tumor resection as well as plastic-reconstructive surgery permit one to perform radical tumor excision in more than 95% of cases and to close large defects and to largely preserve function of the extremity by transplantation of muscles, tendons and bones as well as transplantations of nerves and blood vessels. The plastic reconstructions after radical tumor resection are often demanding and complex and require intensive interdisciplinary cooperation. This consists of the full spectrum of plastic surgical options, which should be performed in specialized centers and be specifically adapted to the patient and case profile. In this review different options for functional reconstruction after radical oncological removal of soft-tissue sarcomas are presented.