背景:前臂游离皮瓣成形术(RFFF)是一套复杂的重建程序,旨在为变性患者创造美观和功能性的阴茎。新生阴茎和供体部位的感觉恢复对于优化结果至关重要,但是,现有的少数研究在有限的位置和时间点评估新生的感觉。这项研究的目的是前瞻性地量化RFFF球囊成形术后新生阴茎和供体部位的感觉结果。
方法:在2019年2月至2021年1月期间,使用压力指定的感觉装置(PSSD)对1期RFFF阴茎成形术患者进行了前瞻性感觉测试。在新人类身上,在近端到远端的六个周向位置测量了单点判别(1PS)压力阈值和纵向感觉恢复。在捐赠现场,在供体手上的三个位置测量1PS。
结果:纳入19例患者(平均年龄34.0岁,范围18-53年)。在接受新生儿检查的患者中(n=13),八人至少有两次后续预约。这些患者中有6人在最近的测量中有感觉(75.0%),平均73天才能恢复感觉。右侧腹侧感觉的患者比例明显更高(3个月后80.0%vs.3个月前11.1%-60.0%,p=0.024)和右外侧(3个月后100.0%vs.3个月前11.1%-60.0%,p=0.004)随着时间的推移,新生阴茎的各个方面。术后1周至1个月至术后3-7.7个月,右腹侧新生阴茎产生感觉所需的压力降低了18.0%(96.2g/mm2±11.3g/mm2至56.6±39.9g/mm2,p=0.037)。在接受供体部位检测的患者中(n=11),随机截距的混合效应回归分析显示,拇指(3.4g/mm2±1.4g/mm2,p<0.05)和网络空间(13.5g/mm2±4.9g/mm2,p<0.01)在术后3个月恢复至基线(分别为1.7g/mm2±1.0g/mm2,p>0.05和2.3g/mm2±4.0g/mm2,p>0.05)显著变化.
结论:这项初步研究表明,定量感觉测试可用于监测阴囊成形术后的感觉变化。恢复与对侧显着相关(i。e,左前臂RFF中的右侧)新生阴茎的方面,提示通过RFFF感觉神经的圆周感觉神经支配的可能模式。未来的研究需要更大的样本量和更长的随访时间,以充分表征阴茎成形术患者的感觉恢复。
BACKGROUND: Radial forearm free flap phalloplasty (RFFF) is a set of complex reconstructive procedures aimed at creating an aesthetic and functional penis in transgender patients. Sensory recovery in the neophallus and donor site is crucial for optimizing outcomes, but the few prior studies that exist assess neophallus
sensation at limited locations and time points. The purpose of this study was to prospectively quantify sensory outcomes in the neophallus and donor site following RFFF phalloplasty.
METHODS: Sensation testing occurred prospectively over February 2019-January 2021 on Stage 1 RFFF phalloplasty patients using the Pressure Specified Sensory Device (PSSD). On the neophallus, one-point discrimination (1PS) pressure threshold and lengthwise sensory recovery were measured at six circumferential locations proximally to distally. On the donor site, 1PS was measured at three locations on the donor hand.
RESULTS: Nineteen patients were included (average age 34.0 years old, range 18-53 years). Among patients that received neophallus testing (n = 13), eight had at least two follow-up appointments. Six of these patients had
sensation as of their most recent measurement (75.0%), with an average of 73 days to regain
sensation. There was a significantly greater proportion of patients with sensation at the right ventral (80.0% after 3 months vs. 11.1%-60.0% before 3 months, p = 0.024) and right lateral (100.0% after 3 months vs. 11.1%-60.0% before 3 months, p = 0.004) aspects of the neophallus over time. Pressure required to elicit
sensation decreased by 18.0% from 1 week-1 month postoperatively to 3-7.7 months postoperatively in the right ventral neophallus (96.2 g/mm2 ± 11.3 g/mm2 to 56.6 ± 39.9 g/mm2, p = 0.037). Among patients that received donor site testing (n = 11), mixed effects regression analysis with random intercepts demonstrated significant changes in the thumb (3.4 g/mm2 ± 1.4 g/mm2, p < 0.05) and webspace (13.5 g/mm2 ± 4.9 g/mm2, p < 0.01) that returned to baseline at 3 months postoperatively (1.7 g/mm2 ± 1.0 g/mm2, p > 0.05, and 2.3 g/mm2 ± 4.0 g/mm2, p > 0.05, respectively).
CONCLUSIONS: This pilot study demonstrates that quantitative sensory testing can be used to monitor post-phalloplasty sensory changes. Recovery was significantly associated with contralateral (i.e, right side in a left forearm RFF) aspects of the neophallus, suggesting a possible pattern of circumferential sensory innervation via RFFF sensory nerves. Future studies with a larger sample size and longer follow-ups are necessary to fully characterize sensory recovery in phalloplasty patients.