Sculpturing the glans in phalloplasty.

One of the goals of phalloplasty is the construction of an aesthetically appealing neophallus with a urethral meatus at its tip. Aesthetic considerations imply the creation of a glanslike structured tip. A review of the scarce literature on sculpturing of a glans is given. In cases in which microsurgical free-flap techniques are applied in our hospital, the glans is usually sculptured to its final appearance during the actual phalloplasty. If, on the other hand, an abdominal or inguinal skin flap is used, final sculpturing will be done as a subsequent separate procedure. From a review of the literature on this subject and from our experience, one may conclude that the Norfolk technique of coronal ridge and sulcus construction has best results. We consider Munawar's technique to be obsolete, since it tends to lead to flattening of the coronal ridge.