Neophalloplasty in female-to-male transsexuals with the island tensor fasciae latae flap

In the past 60 years, several different procedures have attempted to achieve a postoperative neophallus that is as aesthetic and as functional as possible after penile amputation or sex reassignment. Recently, with improvements in free tissue transfer and microvascular technique, many free flap procedures have been developed with the goal of an aesthetically acceptable neophallus of adequate bulk that enables urination in a standing position and sexual intercourse, with minimal functional and aesthetic donor-site defects. Most authors currently agree that the method of choice for penile reconstruction is microsurgical free tissue transfer, although it does not always fulfill all of the aforementioned goals in a predictable manner. In fact, complete urethroplasty, penile rigidity, and donor-site disfigurement remain challenges, thus making this operation one of the most difficult in plastic surgery. The vascular anatomy of the lateral circumflex femoral artery, which we studied in 1991 with the anatomic dissection of 27 cadavers, gave us the idea to use a long tensor fasciae latae neurovascular island flap as a donor source for neophalloplasty. Grounds for the procedure and its surgical planning have been carefully evaluated with 10 additional fresh cadaver dissections. Since 1991, we have performed five neophalloplasties using this procedure; all patients were female-to-male transsexuals. In four cases, the healing was uneventful; in one case, there was a marginal necrosis of the flap because of poor venous drainage, probably from a twisting of the pedicle. The island tensor fasciae latae provides a safe and sensate flap for phalloplastic procedure and leaves a less conspicuous donor scar.     

Evaluation of body contouring surgery today: a 30-year perspective

Concepts of beauty have been continuously evolving throughout the history of mankind. The voluptuous figures that were idealized by artists in the past have been substituted by slimmer forms. Medical advances in this century have permitted safe and efficient surgical correction of contour deformities. Until recently, these alterations were mostly hidden under heavy clothing or were accepted reluctantly. Current fashion trends generally promote body-revealing attire. The media frequently encourage the importance of fitness and good health, linking these qualities with youthfulness and beauty. The subliminal and the overt message is that these are necessary and desirable requirements for social acceptance and professional success.     

Long-term fate of the bony component in neophallus construction with free osteofasciocutaneous forearm or fibula flap in 18 female-to-male transsexuals

Female-to-male transsexuals have been operated on in the authors' department since 1975. Between 1981 and 1995, 46 patients underwent neophallus construction with a free osteofasciocutaneous forearm or fibula flap. The bony part of these flaps is embedded in tissue with excellent blood circulation, has no contact with the skeleton, and is free of mechanical stress. To evaluate the long-term fate of the bony component of these flaps, the authors examined 18 of the 46 patients (39.1 percent) who had received a neophallus by means of one of these methods (12 with forearm and six with fibula flap) and who were willing to participate in the updating of the results of the previous two decades; this represented a follow-up of 5 to 112 months postoperatively (average, 27.4 months). The following investigations were undertaken: clinical and radiologic examination, bone scintigraphy, magnetic resonance imaging, and histologic examination of the neophallus bony component. In all patients, the clinical examination showed no significant variations in the shape and rigidity of the neophallus bone. The radiologic examination showed a compact bone structure, and the magnetic resonance imaging proved the vitality of the neophallus in all patients, with no significant changes over time. Bone scintigraphy did not prove to be useful in determining the long-term fate of the neophallic bony component. Histologically, subperiosteal neoformation of fibrous bone was shown, whereas the lamellar cortical bone was predominantly avital. The results of this study reveal the vitality of the bony component in neophallus construction with free osteofasciocutaneous flaps. Even 112 months after the procedure, it provided sufficient stiffness for sexual intercourse. This continuing adequate rigidity of the bony component, in addition to the well-known advantages of the free osteofasciocutaneous flap, is further evidence of its usefulness in neophallus construction.     

Kavosh: a new algorithm for finding network motifs

Background  

Complex networks are studied across many fields of science and are particularly important to understand biological processes. Motifs in networks are small connected sub-graphs that occur significantly in higher frequencies than in random networks. They have recently gathered much attention as a useful concept to uncover structural design principles of complex networks. Existing algorithms for finding network motifs are extremely costly in CPU time and memory consumption and have practically restrictions on the size of motifs.     

Temporalis muscle hypertrophy: a new plastic surgery procedure

Bilateral hypertrophy of the temporal muscle can give the impression of a harsh facial appearance that manifests itself as a morphopsychological conflict for the subject involved (Minotaur syndrome). This article describes a new facial aesthetic surgical procedure in the area of the temporal muscle. The author describes the surgical technique and the surgical instrument that he developed specifically for performing aesthetic contouring of the temporal area by reducing the muscle volume discrepancy ("myosuction"). The follow-up results of 11 cases demonstrated that this procedure renders valid results in the overall aesthetic reharmonization of the face and an improvement of individual psychological well-being.     

Temporal fossa bone grafts: a new technique in craniofacial surgery

The calvarium has become an increasingly popular bone-graft donor site. Previously described harvesting techniques are often difficult to perform and may produce unsatisfactory bone fragments. However, full-thickness bone grafts taken from the region of the temporal fossa, beneath the temporaiis muscle, have proven to be of high quality and technically easy to obtain. In our experience with eight patients, temporal fossa bone grafts were used primarily around the orbit, including reconstruction of the orbital floor, frontal bone, and zygoma. The procedure begins with a hemicoronal or bicoronal incision; the temporalis muscle is reflected, and an underlying bone plate up to 4 X 6 cm is removed. The resulting bone graft is consistently 3 to 4 mm in thickness. The cranial defect is packed with bone debris, and the muscle is replaced. This technique has proven to be safe, technically simple, consistently productive of high-quality bone grafts, and within discernible donor-site deformity.     

Mandibular contouring: a surgical technique for the asymmetrical lower face

Correcting facial asymmetry is a difficult problem for plastic surgeons. From 1991 to 1996, the authors treated 53 cases of mandibular angle resection, 13 of which were of patients with an asymmetrical lower face. On the basis of these experiences, the authors highlight two important points in dealing with the asymmetrical lower face. The first is accurate resection of each side of the face. A cloth pattern was used to improve the accuracy of the procedure and to make the final result match the preoperative design regarding amount and shape. The second concerns soft-tissue change after the operation. Satisfactory results are obtained by the accurate resection of the bone coupled with the correct management of the surrounding soft tissue. The amount of bone to be resected was determined not simply by cephalometry, but by both cephalometry and external appearance. Postoperative cephalometry is not always symmetrical, and it is important that the final external appearance be harmonious and symmetrical. Using the above method, results have been satisfactory to both the surgeons and the patients, with the exception of three patients who had residual asymmetry. No permanent sensory loss or motor nerve palsy was observed, and no infections occurred.