PEDICLED FLAP 肉莖蓋皮術
STAGE ONE 第一步
A pedicled flap is a tube of skin created from either the flank area or lower abdomen to construct a phallus. My preference is to use the groin flap, since this usually scars well, and doesn't require the use of skin grafts. This operation does require several stages. The first is the creation of a phallus, which is attached to the pubis and to its site of origin much like a "suitcase handle". This is done as an outpatient procedure, but I prefer that the patients stay overnight in the hospital as a guest in the VIP section.
STAGE TWO 第二步
The secondary procedure is called a "delay" and is meant to improve the blood supply of the penis. This minor procedure is done one month after the original procedure to partially separate the flap from the flank. The delay can be done in my clinic operating room. Patients need to stay one night in Portland. n Portland. A minimum of one surgical delay is necessary. Following this, the patient can enhance the blood supply, at home, by using a temporary tourniquet around the base.
STAGE THREE 第三步
大約第一次手術三個月之後，就可以開始次要的步驟。例如可以在陰莖上雕出龜頭，並安置勃起裝置以利陰道性交，或者也可以做出陰囊。以上每個步驟都得分開執行，以保存陰莖蓋皮的血液供給；所有步驟都不必住院，但最好停留一晚。這個手術的主要好處在於提供一個尺寸和大小都很可觀的陰莖，再加上龜頭塑型手術，看來就很自然。最後的結痂位於側腹部位，通常癒後狀況很好。不過這個手術最大的缺點就是陰莖不敏感。由於這個手術創造的陰莖蓋皮必須從恥骨處重建血液的供應，血液供給量比顯微手術創造的前臂陰莖蓋皮來得微弱，因此當蓋皮自鼠蹊處脫開時會有壞死的風險。這也是我使用「延緩」來增進血液供應的原因；若能按照以上所述的步驟施行，手術的結果是很不錯的。另外，由於陰莖的開口感應遲鈍，因此勃起裝置也可能爛穿陰莖皮。本手術不建議延長尿道，因為這要冒很大的風險，可能導致縮窄或不正常的排尿問題（如瘺管）。Approximately three months after the first operation, secondary procedures can be done. For example, a glans can be sculpted on the phallus, an inflatable erection device can be placed to allow vaginal intercourse, or a scrotum can be formed. Each of these procedures must be done separately to preserve the blood supply to the flap. All are outpatient procedures that require one night in Portland. The principal advantage of this operation is that it does provide a penis of significant size and bulk. Following creation of the glans, it can also look quite natural. The final scar is located over the flank area and usually heals quite well. The greatest disadvantage is that the penis will lack sensation. Because this flap must re-establish its blood supply from the pubis, it has a more tenuous blood supply than the microsurgically created radial forearm flap. Therefore, there is a risk of the flap dying when it is separated from the groin. This is the reason that I use the delay operations to enhance the blood supply, and when using the above described schedule the operation is very reliable. Since the shaft of the penis is insensate, the erectile device will also have a greater risk of eroding through the penile skin. Lengthening of the urethra is ill advised in this operation, because there is a profound risk of problems including strictures or abnormal drainage of the urine (fistula).