{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:22:32Z","timestamp":1781623352567,"version":"3.54.5"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,4,26]],"date-time":"2019-04-26T00:00:00Z","timestamp":1556236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2019,4,26]],"date-time":"2019-04-26T00:00:00Z","timestamp":1556236800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The free radial forearm (FRFA) flap is universally still considered as the gold standard technique in penile reconstruction. Typically, a considerably large flap is required, often involving almost the entire circumference of the forearm. Partial necrosis may occur at the distal-most (dorsoradial) part of the flap as a result of insufficient perfusion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To describe a new technique using the posterior interosseous artery (PIOA) to supercharge FRFA phalloplasty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a 12-month period, all patients having FRFA flap phalloplasty were enrolled. Perioperative, after complete flap dissection, an indocyanine green perfusion scan was performed. In case of insufficient perfusion at the distalmost part of the flap, a supramicrosurgical anastomosis was performed between the FRFA pedicle and the PIOA (artery only).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measures<\/jats:title>\n                  <jats:p>Studied outcomes included the rate of marginal necrosis, surgical time, postoperative posterior interosseous nerve damage and urethral complications (fistula, stenosis or necrosis).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 27 FRFA flap phalloplasties was performed. Anastomosis of the PIOA was needed in 15 cases. No marginal necrosis was observed in these cases. There were no cases of postoperative posterior interosseous nerve damage. There were no significant differences in urethral complications (fistula, stenosis or necrosis) between the 2 groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>In selected cases where insufficient perfusion of the dorsoradial part of the flap is present, patients may benefit from arterial supercharging to prevent postoperative marginal necrosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strength &amp; Limitations<\/jats:title>\n                  <jats:p>Strengths include a single surgeon, thus lending continuity of skill and technique, a consecutive series, and 100% short-term follow-up. Limitations include single institution series and a limited number of patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Arterial supercharging is effective in improving perfusion of large FRFA flaps used in phalloplasty when dorsoradial hypoperfusion is detected on an indocyanine green perfusion scan. It is a technically challenging addition to the standard technique because of the small size of the vessels, the close relationship between the PIOA and the posterior interosseous nerve, and the vulnerability of the newly constructed intra-flap anastomosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2019.03.270","type":"journal-article","created":{"date-parts":[[2019,4,26]],"date-time":"2019-04-26T11:57:25Z","timestamp":1556279845000},"page":"1111-1117","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":10,"title":["Free Bipedicled Radial Forearm and Posterior Interosseous Artery Perforator Flap Phalloplasty"],"prefix":"10.1093","volume":"16","author":[{"given":"Edward","family":"De Wolf","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery , Ghent, \u00a0 Belgium"},{"name":"Gent University Hospital , Ghent, \u00a0 Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Claes","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery , Ghent, \u00a0 Belgium"},{"name":"Gent University Hospital , Ghent, \u00a0 Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper E.","family":"Sommeling","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery , Ghent, \u00a0 Belgium"},{"name":"Gent University Hospital , Ghent, \u00a0 Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dries","family":"Opsomer","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery , Ghent, \u00a0 Belgium"},{"name":"Gent University Hospital , Ghent, \u00a0 Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Cherubino","sequence":"additional","affiliation":[{"name":"Microsurgery and Lymphatic Surgery Research Centre , Varese, \u00a0 Italy"},{"name":"Department of Biotechnology and Science of Life , Varese, \u00a0 Italy"},{"name":"University of Insubria , Varese, \u00a0 Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Vieni","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncological and Oral Sciences , Palermo, \u00a0 Italy"},{"name":"University of Palermo , Palermo, \u00a0 Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stan","family":"Monstrey","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery , Ghent, \u00a0 Belgium"},{"name":"Gent University Hospital , Ghent, \u00a0 Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"D\u2019Arpa","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery , Ghent, \u00a0 Belgium"},{"name":"Gent University Hospital , Ghent, \u00a0 Belgium"},{"name":"Plastic and Reconstructive Surgery , Palermo, \u00a0 Italy"},{"name":"Department of Surgical Oncological and Oral Sciences , Palermo, \u00a0 Italy"},{"name":"University of Palermo , Palermo, \u00a0 Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,26]]},"reference":[{"key":"2023012309430791600_bib1","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/PRS.0b013e3181aeeb06","article-title":"Penile reconstruction: Is the radial foream flap really the standard technique?","volume":"124","author":"Monstrey","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"2023012309430791600_bib2","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1055\/s-0032-1333271","article-title":"Preoperative planning of a pedicled anterolateral thigh (ALT) flap for penile reconstruction with the multidetector CT scan","volume":"45","author":"Sinove","year":"2013","journal-title":"Handchir Mikrochir Plast Chir"},{"key":"2023012309430791600_bib3","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/00006534-198408000-00014","article-title":"Forearm flap in one-stage reconstruction of the penis","volume":"74","author":"Chang","year":"1984","journal-title":"Plast Reconstr Surg"},{"key":"2023012309430791600_bib4","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/00000637-198702000-00006","article-title":"New concept in phallic reconstruction","volume":"18","author":"Gilbert","year":"1987","journal-title":"Ann Plast Surg"},{"key":"2023012309430791600_bib5","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1002\/micr.1920140910","article-title":"Addressing the ideal requirements by free flap phalloplasty: Some reflections on refinements of technique","volume":"14","author":"Hage","year":"1993","journal-title":"Microsurgery"},{"key":"2023012309430791600_bib6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.hcl.2013.12.003","article-title":"Anatomy and physiology of perforator flaps of the upper limb","volume":"30","author":"Appleton","year":"2014","journal-title":"Hand Clin"},{"key":"2023012309430791600_bib7","first-page":"270","article-title":"Posterior interosseous artery perforator flap","author":"Shibata","year":"2006","journal-title":"Perforator flaps"},{"key":"2023012309430791600_bib8","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/SAP.0b013e31802f8408","article-title":"Distally based posterior interosseous flap: Primary role in soft tissue reconstruction of the hand","volume":"59","author":"Agir","year":"2007","journal-title":"Ann Plast Surg"},{"key":"2023012309430791600_bib9","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1016\/j.bjps.2009.01.065","article-title":"Free posterior interosseous artery perforator flap for finger reconstruction","volume":"62","author":"Ishiko","year":"2009","journal-title":"J\u00a0Plast Reconstr Aesthet Surg"},{"key":"2023012309430791600_bib10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1055\/s-0037-1606536","article-title":"Application of indocyanine green in flap surgery: A systematic review","volume":"34","author":"Li","year":"2018","journal-title":"J\u00a0Reconstr Microsurg"},{"key":"2023012309430791600_bib11","first-page":"920","article-title":"New technique for coronaplasty in penile reconstruction","volume":"15","author":"Sommeling","year":"2018","journal-title":"J\u00a0Sex Med"},{"key":"2023012309430791600_bib12","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/00006534-198269010-00009","article-title":"The importance of arterial inflow in the distal side of a flap: An experimental investigation","volume":"69","author":"Nakayama","year":"1982","journal-title":"Plastic & Reconstructive Surgery"},{"key":"2023012309430791600_bib13","doi-asserted-by":"crossref","first-page":"e0160942","DOI":"10.1371\/journal.pone.0160942","article-title":"Effects of venous superdrainage and arterial supercharging on dorsal perforator flap in a rat model","volume":"11","author":"Zheng","year":"2016","journal-title":"PLoS One"},{"key":"2023012309430791600_bib14","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1055\/s-2007-1006581","article-title":"Which vessel is more important in the supercharged flap\u2014artery, vein, or both? An experimental study","volume":"10","author":"Ueda","year":"1994","journal-title":"J\u00a0Reconstr Microsurg"},{"key":"2023012309430791600_bib15","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/01.prs.0000299185.32881.55","article-title":"Effect of recipient arterial blood inflow on free flap survival area","volume":"121","author":"Shimpei","year":"2008","journal-title":"Plast Reconstr Surg"},{"key":"2023012309430791600_bib16","doi-asserted-by":"crossref","first-page":"e0171651","DOI":"10.1371\/journal.pone.0171651","article-title":"What\u2019s the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply?","volume":"12","author":"Zhang","year":"2017","journal-title":"PLoS One"},{"key":"2023012309430791600_bib17","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/01.PRS.0000095953.57320.2F","article-title":"Comparison of three different supercharging procedures in a rat skin flap model","volume":"113","author":"Chang","year":"2004","journal-title":"Plast Reconstr Surg"},{"key":"2023012309430791600_bib18","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1055\/s-0034-1371355","article-title":"The delay phenomenon: A compilation of knowledge across specialties","volume":"7","author":"Hamilton","year":"2014","journal-title":"Craniomaxillofac Trauma Reconstr"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609519307325?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609519307325?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/16\/7\/1111\/48588667\/jsm_16_7_1111.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/16\/7\/1111\/48588667\/jsm_16_7_1111.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T10:19:47Z","timestamp":1674469187000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/16\/7\/1111\/6980533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,26]]},"references-count":18,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,4,26]]},"published-print":{"date-parts":[[2019,7,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2019.03.270","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2019,7]]},"published":{"date-parts":[[2019,4,26]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Free Bipedicled Radial Forearm and Posterior Interosseous Artery Perforator Flap Phalloplasty","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2019.03.270","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}