Gender-affirming Phalloplasty: A Postoperative Protocol for Success.

Autor:	Rifkin WJ; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y., Daar DA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y., Cripps CN; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y., Mars G; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y., Zhao LC; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y.; Department of Urology, NYU Langone Health, New York, N.Y., Levine JP; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y., Bluebond-Langner R; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y.; Department of Urology, NYU Langone Health, New York, N.Y.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2022 Jun 20; Vol. 10 (6), pp. e4394. Date of Electronic Publication: 2022 Jun 20 (Print Publication: 2022).
DOI:	10.1097/GOX.0000000000004394
Abstrakt:	Increased access to care and insurance coverage has led to an increase in gender-affirming surgeries performed in the United States. Gender-affirming phalloplasty has a variety of donor sites and surgical techniques including both pedicled and free flaps. Although surgical techniques and patient outcomes are well-described, no reports in the literature specifically discuss postoperative management, which plays a crucial role in the success of these operations. Here, we present a postoperative protocol based on our institution's experience with gender-affirming phalloplasty with the hope it will serve as a standardized, reproducible reference for centers looking to offer these procedures. Methods: Patients undergoing gender-affirming phalloplasty at our institution followed a standardized protocol from the preoperative stage through phases of postoperative recovery. Medication, laboratory, physical and occupational therapy, flap monitoring, and dressing change guidelines were extracted and compiled into a single resource detailing the postoperative protocol in full. Results: Our institution's standardized postoperative protocol for gender-affirming phalloplasty is detailed, focusing on flap monitoring, mobilization and activity, medications, and postoperative dressing care. One hundred thirty first-stage phalloplasty procedures were performed between May 2017 and December 2021, with two patients (1.5%) experiencing partial necrosis and one incidence (0.8%) of total flap loss. Conclusions: For optimal and safe surgical outcomes, the surgical and extended care teams need to understand flap monitoring as well as specific postoperative protocols. A systematic approach focusing on flap monitoring, mobilization and activity, medications, and postoperative dressing care decreases errors, accelerates recovery, shortens length of stay, and instills confidence in the patient. (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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