Two antebrachial nerves were coapted to the ilioinguinal nerve and to one of the dorsal clitoral nerves to provide protective and erogenous selleck screening library sensitivity. The initial postoperative course was uneventful. Unfractionated heparin (10,000 IU) was applied for the first 24 hours, followed by prophylactic fractionated heparin (5,000 IU). 100 mg acetylsalicylic acid was administered after postoperative

day (POD) 1. Flap monitoring was assessed clinically and by handheld Doppler by trained nursing personnel every hour for the first 24 hours, then every 3 hours until POD 4, and afterwards once per nursing shift. At the end of postoperative week 2, we observed a partial flap necrosis affecting the full length of both lateral flap borders leading to a complete necrosis of the neo-urethra and

of a 2 cm wide strip on the ventral outer lining of the neo-phallus (Fig. 1, left). Debridement of the necrotic areas resulted in a complete resection and loss of the neo-urethra and a part of the ventral outer lining of the neo-phallus (Fig. 1, right). A second free RFF from BI 2536 nmr the contralateral side was harvested as a salvage procedure to reconstruct both the neo-urethra and the necrotic part of the outer lining of the neo-phallus. A modified, shortened Chang-design was harvested from the so far intact right forearm: the part of the flap used for neo-urethra-reconstruction measured 3.5 cm × 14 cm, followed by a 0.5 cm wide, de-epithelialized strip and a shortened strip of 3 cm × 11 cm for the reconstruction of the outer lining of the neo-phallus (Fig. 2). The neo-urethal part was wrapped around a 17 Ch foley catheter with the skin-inside and closed onto the de-epithelialized strip. After urethral reanastomosis to the lengthened pars fixa, the remaining outer lining of the initial neo-phallus was wrapped around it. The phallic part of the second flap was incorporated into the ventral outer lining in order to regain a sufficient circumference (Figs. 3 Megestrol Acetate and 4). The microvascular

anastomoses were performed in the intact left groin with an end-to-side anastomosis of the radial artery onto the common femoral artery. One of the comitant veins and a total of three subcutaneous veins of the flap were connected onto branches of the great saphenous vein in an end-to-end fashion. No nerve reconstruction was performed. The donor-site was covered with FTSG. A summarizing illustration of the surgical technique is given in Figure 5. Postoperatively, the same pharmacological and flap screening protocol was applied as for the first RFF. The postoperative courses were uneventful. No flap-related complications occurred. After discharge, clinical examinations took place at the outpatient clinics 1, 3, 6, and 12 months postoperatively.