One-stage phalloplasty in transsexuals.

Until now, phalloplasty in transsexuals has been done with cutaneous and musculocutaneous flaps from the abdomen or the thigh in multiple procedures over a long period. We report a one-stage phalloplasty in female transsexuals with a modified Chinese forearm flap, including the cutaneous nerves anastomosed to the genital branches of the ilioinguinal and iliohypogastric nerves and the perineal branches of the pudendal nerve to obtain true genital sensibility. Immediate hysterectomy and vaginal closure are performed, providing vaginal skin to complete the neoscrotum built up with the labia and to cover the glans. A vaginal flap draped around the catheter provides the urethra, which is stripped through the dermal tube of the forearm flap acting as a corpus spongiosum. Autogenous costal cartilage is used as a stent for reinforcement, substituting for the corpora cavernosa. The donor forearm area is covered with split skin.

[Choice of microvascular anastomoses in reconstructive surgery]. / Uberlegungen zur Wahl mikrovaskulärer Anastomosen in der rekonstruktiven Chirurgie.

For reconstruction of traumatic defects, choosing the most suitable free flap and vessels for microvascular anastomoses is paramount. Careful clinical examination, followed by a Doppler-ultrasonography and arteriography is mandatory. An end-to-end anastomosis is desirable if the artery is interrupted distally. In all other cases end-to-side anastomoses should be used since they do not compromise distal blood flow. In the case of the "chinese" forearm free flap, one should always reconstruct the donor radial artery with a vein graft to assure optimal blood supply of the hand. This free flap should not be used in the rare cases where the arterial arcade of the hand is absent.

[Treatment of sequelae of burns on the trunk]. / Die Behandlung von Spätfolgen nach Verbrennungen im Bereichedes Rumpfes]

The management of burn scars of the trunk is discussed, in respect of the specific problems related to different areas such as the axilla, thorax and back, the female breast and the perineum as well as the external genitalia. Special emphasis is placed on the different aspects of burn sequelae of the female breast with regard to pre- and postpuberty age. The prevention and therapy of the burn scar carcinoma are dealt with.