RESUMEN
While aesthetic facial surgery performed for reasons of undesired facial masculinity or femininity has had some attention in the literature, there is a lack of information on gender-confirming facial surgery as part of an overall surgical sex reassignment program. In this paper we try to capture some of the sex differences, respectively, of skeleton, musculature and other subcutaneous soft tissues, integument and frame of the face. From this, we come to a description of some general differences of facial appearance between the sexes. In restructuring the skeletal architecture and facial proportions to match the desired gender, these factors should be taken into account.
Asunto(s)
Estética , Cara/anatomía & histología , Caracteres Sexuales , Cefalometría , Dentición , Procedimientos Quirúrgicos Dermatologicos , Trastornos del Desarrollo Sexual/cirugía , Ojo/anatomía & histología , Cejas/anatomía & histología , Cara/cirugía , Huesos Faciales/anatomía & histología , Huesos Faciales/cirugía , Músculos Faciales/anatomía & histología , Músculos Faciales/cirugía , Femenino , Frente/anatomía & histología , Cabello/anatomía & histología , Humanos , Masculino , Mandíbula/anatomía & histología , Cuello/anatomía & histología , Nariz/anatomía & histología , Órbita/anatomía & histología , Sexo , Piel/anatomía & histología , Cráneo/anatomía & histología , Cirugía Plástica , Cigoma/anatomía & histologíaRESUMEN
Replantation is the treatment of choice in scalping injuries and should always be considered, even in case of a badly damaged scalp. Specific procedures regarding pre-, intra- and postoperative care are crucial to success in replantation. These include: haemodynamic stabilization of the patient without causing damage to possible donor vessels; cooling, cleaning and further proper care of the avulsed specimen; use of antibiotics and haemodilution to optimize the intra- and post-operative situation. The above is illustrated by a case history of successful replantation of a seriously damaged avulsed scalp.
Asunto(s)
Cuero Cabelludo/lesiones , Cuero Cabelludo/cirugía , Adulto , Femenino , Humanos , Cicatrización de HeridasRESUMEN
We devised a technique for phalloplasty in a female-to-male transsexual combining the lateral upper arm free flap with a bladder mucosa graft, to address the ideal requirements of phalloplasty in the best possible way. The surgical techniques are described. Healing of the phallus has been uneventful, but postoperative bladder spasms, meatal stenosis, and an intraurethral valve were encountered. The cosmetic result of the phalloplasty is pleasing. Sensibility is still increasing after a 14-month follow-up. Scarring of the upper arm donor site can be camouflaged easily. Although the actual phalloplasty as described in this article is a one-stage microsurgical procedure that appears to be reproducible, the construction of a phallus meeting all requirements still implies more than one stage.
Asunto(s)
Pene/cirugía , Colgajos Quirúrgicos/métodos , Transexualidad/cirugía , Vejiga Urinaria/cirugía , Adulto , Brazo/cirugía , Femenino , Genitales Femeninos/cirugía , Humanos , Masculino , Membrana Mucosa/trasplanteRESUMEN
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.
Asunto(s)
Pene/cirugía , Cirugía Plástica/métodos , Transexualidad/cirugía , Femenino , Humanos , Masculino , Colgajos Quirúrgicos/métodosRESUMEN
Until April 1991, 31 phalloplasties were performed in 28 patients at our hospital. Operative techniques and results of the use of the superficial inferior epigastric pedicled skin flap, rectus abdominis myocutaneous pedicled flap and radial forearm free flap for phalloplasty are presented and discussed. Functionally and cosmetically, the microsurgical free flap phalloplasty techniques lead to the best results. In all cases of free flap phalloplasty in our series tactile sensitivity recurred in the neophallus. However, erogenous sensibility should not be expected. We regard use of the infraumbilical flap to be a technique with few indications and it should not be applied to obese patients. Use of the rectus abdominis myocutaneous pedicled flap is a reliable technique. Primary connection of the pars fixa and pars pendulans urethrae often leads to formation of fistulas at the level of the anastomosis. Genital reassignment surgery in female-to-male transsexuals can seldom be achieved in 1 stage and this should be made clear to the patient before any form of surgery is done.
Asunto(s)
Pene/cirugía , Cirugía Plástica/métodos , Transexualidad/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Colgajos Quirúrgicos/métodos , Factores de TiempoRESUMEN
Ideally, in phalloplasty one should aim at 1) a one-stage procedure that can be predictably reproduced, 2) creation of a competent neo-urethra to allow for voiding while standing, 3) return of both tactile and erogenous sensibility, 4) enough bulk to tolerate the insertion of a prosthetic stiffener, and 5) a result that is aesthetically acceptable to the patient. We consider 6) minimal scarring or disfigurement, and 7) no functional loss in the donor area further requirements for any ideal procedure. Thanks to ongoing refinements, microsurgical free flap phalloplasty techniques lead to the best results, both functionally and cosmetically. These refinements are presented and discussed, as are our experiences applying them.
Asunto(s)
Pene/cirugía , Colgajos Quirúrgicos/métodos , Transexualidad/cirugía , Femenino , Humanos , Masculino , Microcirugia/métodos , Prótesis e Implantes , Colgajos Quirúrgicos/efectos adversos , Uretra/cirugíaRESUMEN
Five patients with deformities of the index finger are presented. We believe all five are due to finger sucking. The deformity usually consists of a combination of rotation, radial deviation in the metacarpal phalangeal joint, and hyperextension in the proximal interphalangeal joint; one of these is more pronounced. In our series the rotational deformity and deviation were the most prominent features. Cause, incidence, and other factors influencing this deformity as well as spontaneous regression and therapy are discussed.