{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:52:12Z","timestamp":1776905532467,"version":"3.51.2"},"reference-count":13,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,10,16]],"date-time":"2021-10-16T00:00:00Z","timestamp":1634342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Revision surgery after gender\u2010affirming genitoplasty is becoming more and more common as more patients gain access to surgical treatment. The complexity of genitoplasty and extensive dissection of delicate tissues predisposes patients to necrosis of the flap(s) employed, which can leave patients with complications ranging from poor aesthetics to total lack of genital sensation. The purpose of this report is to detail the revision surgery of a 32\u2010year\u2010old transgender woman who underwent vaginoplasty at an outside institution and presented to our clinic for clitoral reconstruction following necrosis and near\u2010total loss of the neoclitoris. Physical exam showed extensive necrosis, and 3\u2010Tesla magnetic resonance (MRI) revealed significant scarring of the pudendal nerve branches at the level of the pubic symphysis. Healthy nerve was identified at the level of the right inferior pubic ramus, and total clitoral reconstruction with an innervated first dorsal web space free flap anastamosed to the deep inferior epigastric vessels was performed. Complications included donor site cellulitis with partial loss of the skin graft and formation of hypertrophic scar tissue. This was treated 6\u00a0months postoperatively with excision of scar tissue in the webspace and placement of an additional full\u2010thickness skin graft. At follow\u2010up, the patient reported tactile and erogenous sensation of the neoclitoris itself and subjective satisfaction with the aesthetic outcome. Our results provide evidence that this flap is a feasible option to create an aesthetic and sensate neoclitoris in the setting of previous neoclitoral necrosis. This case report also describes the novel use of 3\u2010Tesla MRI in target selection for nerve coaptation.<\/jats:p>","DOI":"10.1002\/micr.30814","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T02:32:18Z","timestamp":1634610738000},"page":"787-791","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sensate total clitoris reconstruction via microneurovascular dorsal foot web space flap with pudendal nerve coaptation"],"prefix":"10.1002","volume":"41","author":[{"given":"Norah","family":"Oles","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Center for Transgender Health Johns Hopkins Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Preston","sequence":"additional","affiliation":[{"name":"Department of General Surgery University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo A.","family":"Leto Barone","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Center for Transgender Health Johns Hopkins Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aadil","family":"Khan","sequence":"additional","affiliation":[{"name":"Targeted Therapy Team, Division of Radiotherapy and Imaging The Institute of Cancer Research  London UK"},{"name":"Department of Plastic Surgery The Royal Marsden Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8458-9710","authenticated-orcid":false,"given":"Devin","family":"Coon","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Center for Transgender Health Johns Hopkins Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,16]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2014.11.008"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31822af8b9"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.6231"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2007.01.070"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2020.01.004"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.21037\/tau.2019.05.04"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60400-0"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12868"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0b013e3181ed355c"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002144"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(77)80048-8"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0284185116668213"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199902000-00022"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.30814","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.30814","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.30814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T13:05:04Z","timestamp":1693227904000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.30814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,16]]},"references-count":13,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1002\/micr.30814"],"URL":"https:\/\/doi.org\/10.1002\/micr.30814","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,16]]},"assertion":[{"value":"2020-08-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}