A new design for the radial forearm free-flap phallic construction.

One-stage phallic construction using the radial forearm free flap was originally reported in 1984. This potentially sensate, thin, minimally hair-bearing flap, whose design incorporated a vascularized urethra, provided significant advantages over previously described multistaged insensate phallic reconstructions. The original design, as described by Chang and Hwang, is limited in size and has the propensity to develop meatal stenosis. This article describes a new design of the radial forearm flap for phallic construction performed on four patients. The techniques described incorporates a centrally located neourethra in continuity with a neoglans. It eliminates the circumferential meatal suture line and, therefore, meatal stenosis without sacrificing phallic length.