A comparison of common femoral and deep inferior epigastric arteries as recipient vessels for free flap phalloplasty: a radiological study

Microsurgical technique, including choice of recipient vessels, is critical for the success of any free tissue transfer. Yet, the topic of recipient vessels for free flap phalloplasty is neglected in the current literature. The aims of this study were to (1) compare the common femoral (CFA) and deep inferior epigastric arteries (DIEA) as recipient vessels and (2) determine if a role exists for routine preoperative CT angiogram (CTA) in free flap phalloplasty.

A review of CTA imaging of 30 patients was undertaken to compare the deep inferior epigastric and common femoral recipient vessels. Images were independently reviewed by two co‐authors using the HorosTM application (GNU Lesser General Public Licence, Version 3.0) and average of the data presented.

The first bifurcation (in Type 2 or 3 DIEAs) was measured at approximately 90 mm from the vessel origin. Microsurgical anastomoses to the DIEA may be expected closer to the origin (approximately 30 mm) and the corresponding vessel diameter at this level is 2.28 – 2.39 mm. The flap pedicle length required to reach CFA & DIEA recipient vessels were similar. Overall, there were no clinically significant differences between hemi-abdomens.

DIEA and CFA are both reliable recipient vessels in free flap phalloplasty. In general, either side is suitable and the well-known Moon and Taylor variations in branching pattern are unlikely to impact on use of DIEA as recipient vessel for phalloplasty, as the anastomoses are proximal to the first bifurcation. Routine preoperative CTA is not indicated.

Level of Evidence: Level III, diagnostic study