The re-innervated Musculocutaneous Latissimus Dorsi (MLD) flap gives the patient the possibility of achieving sexual intercourse without a prosthesis. The voluntary contraction of the phallus is notable soon after the surgery, which leads to changes in diameter, length and shape – the “paradox erection” – of the penis. Some patients are able to use these contractions for sexual intercourse.

The surgical technique entails the penis being built on the back of the MLD flap by rolling up the cutaneous part of the flap into a cylinder shape. A longitudinal strip of the muscle inside the neophallus forms the motoric unit of the neophallus. Through anastomosis the vascular pedicle and the motoric nerve of the free flap were linked end-to-end to the main vascular pedicle of the gracilis muscle and its motoric nerve coming from the obturator nerve on the left thigh.

After the skin has healed, patients are subject to a rehabilitation program of the transferred muscle. The protocol includes electrostimulation of the motor nerve and the LD muscle of the neophallus for at least 6 months. After initial active muscle movement, electrogymnastic exercises continue X times a week until satisfactory voluntary movement of the muscle is achieved.

The voluntary contraction of the penis is a result of the re-innervation of the transferred muscle, and the contraction can be strong enough to stiffen the penis.



ZSI is the only European manufacturer of artificial urinary sphincters and of malleable and inflatable penile implants, as solutions for male urological problems (incontinence), sexual complications (Erectile Dysfunction), and gender identity procedures (prostheses for trans men and women).



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