The“ARM”principle and practice:Preventing postoperative complications of circumcision

Background: As one of the most commonly performed surgical procedures, circumcision may lead to complications. However, studies on preventing postoperative complications are scarce and still insufficient to draw any conclusions. This retrospective study aimed to summarize the surgical principles and consideration for preventing complications after circumcision.Methods: We reviewed 28 patients(aged 3–45 years;median age, 24 years) with prepuce hyperplasia or phimosis treated with our modified circumcision technique. In our modified technique, an accurate incision design is made through the stretch test, the stenosis is released, and veins and lymphatic tissues in the fascia are maintained. These surgical details for preventing complications were abbreviated to “ARM.”Results: None of the patients had complications at the 6-month follow-up postoperatively. Only mild prepuce edema was observed, which returned to the normal condition spontaneously within 2–3 weeks. The diameter of the distal penis increased by 0.4 ± 0.1 cm 6 months after the procedure.Conclusion: The “ARM” principle may help surgeons to prevent postoperative complications of circumcision.Maintaining the fascia during the procedure can increase the diameter of the surgical region.

Prefabricated Anterolateral Thigh Flaps for Phalloplasty in Female-to-Male Transsexuals

Background Phalloplasty is still a challenging operation because of the high urethral complication rate.Several options regarding different flaps can be chosen,but there is still no perfect solution for phalloplasty in female-to-male(FTM)transgender patients.Our group tried to use prefabricated anterolateral thigh(ALT)flaps for phalloplasty to overcome the urethral complications.Methods A total of 21 transgender patients were included from 2010 to 2019.A twostage operation was performed to reconstruct the phallus.The vaginal mucosa was prefabricated as neourethra at the first stage,and the shaft of the phallus was reconstructed at the second stage.Results All reconstructed phallus survived completely in our study,and the satisfaction rate was 76.2%.The total complication rate was 57.1%.The occurrence of fistula and strictures after the operation was 52.4%and 5.8%,respectively Conclusion Prefabricated ALT flaps with vaginal mucosa have a lower stricture rate.This technique provides a simple,effective surgical option in FTM transsexuals.

张氏法阴茎再造术后感觉恢复状况长期随访观察

背景与目的张氏法阴茎再造术一种较新的阴茎再造方法，于1997年首次报道。其基本方法是采用显微外科技术将原有龟头部或者阴茎残端移植到新造阴茎远端。本文旨在观察再造阴茎的感觉恢复情况。方法对27例应用张氏法进行阴茎再造患者进行长期随访。修复时吻合阴茎背神经和前臂外侧皮神经，阴茎背神经作为支配神经。采用四种方法进行触觉评估。结果平均随访时间10．3年，患者平均年龄25．7岁。再造阴茎末端（龟头或者阴茎残端）感觉和术前相似（P〉0．05）。再造阴茎除了在两点辨别觉上更优外（P〈0．01），前臂未手术区与术后皮瓣区（再造阴茎的近端）在感觉上没有差别。再造阴茎远端较近端具有更好的两点辨别觉（P〈0．01）。与单纯应用前臂桡侧游离皮瓣再造的阴茎相比，张氏法再造的阴茎远端具有更好的痛觉（P〈0．01）、振动阈值（P〈0．01）和两点辨别觉（P〈0．01）。结论应用张氏法再造的阴茎具有良好的感觉，尤其是通过转移原有龟头或阴茎残端形成的新龟头部感觉恢复更佳。

吻合神经前臂桡侧游离皮瓣阴茎再造术后感觉

背景与目的经临床证实，吻合神经前臂桡侧游离皮瓣阴茎再造术疗效可靠。本文旨在确定吻合神经皮瓣能否促进再造阴茎的感觉恢复。方法对45例应用前臂桡侧游离皮瓣施行阴茎再造术的患者进行长期随访。其中，28例进行吻合神经皮瓣移植，17例未吻合神经。吻合神经组采用阴茎背神经与前臂外侧皮神经吻接修复。感觉测试项目包括痛觉、温度觉、振动阈值、静态两点辨别觉。测试由一位检查者采用双盲法按标准模式完成。结果平均随访9．1年。患者平均年龄26．4岁（18—48岁）。在痛觉和振动阈值方面，两组患者再造阴茎的近端相近，而吻合神经皮瓣移植组远端部分显著优于未吻合神经组（P〈0．01）。未吻合神经组阴茎敏感度从远端向近端逐渐增加，而吻合神经移植组阴茎近远端感觉较为一致。在温度觉和静态两点辨别觉方面，吻合神经皮瓣移植组在近端和远端均优于未吻合神经组。结论采用吻合神经前臂桡侧游离皮瓣阴茎再造有助于改善再造阴茎的感觉。在能够找到受区功能神经时，应尽可能进行神经吻合。