Prefabrication of the free fibula osteocutaneous flap to create a functional human penis using a controlled fistula method.

Neophalloplasty remains one of the most challenging efforts in plastic and reconstructive surgery. The complex functional and aesthetic requirements are difficult to attain with consistency and safety. The current gold standard technique involves the use of a radial forearm tube-in-tube free flap, which also requires the placement of a stiffening prosthetic device for dual function. We report the safe use of the free fibula osteocutaneous flap to create a functional, cosmetically-acceptable penis utilizing the principles of prefabrication and controlled fistula method in one case of gender dysphoria.