Phalloplasty – Sensate radial forearm free flap for creation of neourethra and neophallus in gender affirmation surgery: A case report



Phalloplasty, Gender affirmation surgery, Radial forearm flap, Neophallus, Penile reconstruction


With an increase in gender affirmation surgery requirements, it is imperative to understand the procedure for phalloplasty. The Radial Forearm Free Flap is one of the most commonly used flaps for the same. We present this case of a 29-year-old patient who underwent phalloplasty by means of a radial artery forearm free flap. Surgical technique has been described including flap design, harvest, recipient site preparation, anastomosis of vessels and nerves, and post-operative care. The patient developed a small area of partial necrosis which was the dorsoulnar border of the flap. The rest of the neophallus and neourethra were viable, sensate and the patient was able to void urine through the neourethra while standing. The radial forearm free flap is a good option for phalloplasty in gender affirmation surgeries. However, surgeons need to be wary of the possibility of necrosis of the dorsoulnar aspect which may be exceeding the radial artery territory.


Download data is not yet available.


Song R, Gao Y, Song Y, et al. The forearm flap. Clin Plast Surg. 1982;9:21.

Biemer E. Penile construction by the radial arm flap. Clin Plast Surg. 1988;15:425.

Chang T-S, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74:251.

Kim S, Dennis M, Holland J, Terrell M, Loukas M, Schober J. The Anatomy of forearm free flap phalloplasty for transgender surgery. Clinical Anatomy. 2018;31:145-51

Gottlieb LJ, Levine LA. A new design for the radial forearm free flap phallic construction. Plast Reconstr Surg. 1993;92:276.

Lawrence A. editor. The Harry Benjamin International Gender Dysphoria Association’s Standards Of Care For Gender Identity Disorders, Sixth Version. [Internet]. World Professional Association For Transgender Health. Available from: [cited 2009 Apr16].

Garcia MM, Christopher NA, De Luca F, Spilotros M, Ralph DJ. Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: The institute of urology, London U.K. experience. Transl Androl Urol. 2014;3:156–62.

Song C, Wong M, Wong CH, Ong YS. Modifications of the radial forearm flap phalloplasty for female-to-male gender reassignment. J Reconstr Microsurg. 2011;27:115–20.

Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Phalloplasty: A review of techniques and outcomes. Plast Reconstr Surg. 2016;138:594–615.

Trombetta C, Liguori G. Management of gender dysphoria: A multidisciplinary approach. Italia: Springer. 2015; p. 249–256






Case Report

How to Cite

Taliat G, Mohan Kumar K, Nagaraj A. Phalloplasty – Sensate radial forearm free flap for creation of neourethra and neophallus in gender affirmation surgery: A case report. J Surg Med [Internet]. 2021 Dec. 1 [cited 2024 May 25];5(12):1224-6. Available from: