1
|
Gardien KLM, Pijpe A, Brouwer KM, Stoop M, Singh SK, Timmermans FW, Vlig M, van Zuijlen PPM, Middelkoop E. Short- and Long-term Outcomes of an Acellular Dermal Substitute versus Standard of Care in Burns and Reconstructions: A Phase I/II Intrapatient Randomized Controlled Trial. Adv Skin Wound Care 2023; 36:540-548. [PMID: 37729164 PMCID: PMC10545063 DOI: 10.1097/asw.0000000000000040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Dermal substitutes promote dermal regeneration and improve scar quality, but knowledge gaps remain regarding their efficacy and indications for use. The authors investigated the safety and short- and long-term efficacy of an acellular dermal substitute in patients with full-thickness wounds. METHODS This intrapatient randomized controlled, open-label, phase I (safety) and phase II (efficacy) study compared treatment with Novomaix (Matricel GmbH), a dermal collagen/elastin-based scaffold, with split-thickness skin graft (STSG) only. The primary safety outcome was graft take at 5 to 7 days postsurgery. Postsurgical scar quality was assessed by measuring elasticity, color, and scores on the Patient and Observer Scar Assessment Scale at 3 months, 12 months, and 6 years. RESULTS Twenty-five patients were included, of which 24 received treatment allocation. Graft take and wound healing were statistically significantly lower/delayed in the dermal matrix group compared with STSG alone (P < .004). Serious adverse events were delayed epithelialization in four dermal matrix and three STSG study areas. At 12 months postsurgery, skin extension (P = .034) and elasticity (P = .036) were better for the dermal matrix group compared with the group receiving STSG alone. Other scar quality parameters at 12 months and 6 years did not differ between treatment arms. CONCLUSIONS The dermal substitute was a safe treatment modality for full-thickness wounds. Compared with STSG alone, time to wound healing was slightly increased. Nevertheless, scar quality at 12 months seemed somewhat improved in the wounds treated with the dermal substitute, indicative of enhanced scar maturation. In the long term, final scar quality was similar for both treatment modalities.
Collapse
Affiliation(s)
- Kim L M Gardien
- Kim L. M. Gardien, MD, is Burn Physician and Anouk Pijpe, PhD, is Epidemiologist and Research Coordinator, Association of Dutch Burn Centres, Beverwijk, the Netherlands; Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; and Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC. Katrien M. Brouwer, PhD, is Senior Researcher, Association of Dutch Burn Centres. Matthea Stoop, RN, is Research Nurse, Association of Dutch Burn Centres; Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam. Simarjeet K. Singh is Research Student, Burn Center, Red Cross Hospital, Beverwijk. Floyd W. Timmermans, MD, PhD, is Clinical Researcher, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; and AMS Institute, Amsterdam UMC. Marcel Vlig, BAS, is Senior Technician, Association of Dutch Burn Centres. Paul P. M. van Zuijlen, MD, PhD, is Plastic Surgeon and Professor of Burn Care, Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; AMS Institute, Amsterdam UMC; and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk. Esther Middelkoop, PhD, is Director of Research and Professor of Wound Healing and Skin Regeneration, Association of Dutch Burn Centres, Beverwijk, the Netherlands; Burn Center, Red Cross Hospital, Beverwijk; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam; and AMS Institute, Amsterdam UMC
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Mokken SE, Özer M, Timmermans FW. Comment: Foreskin restorers: insights into motivations, successes, challenges and experiences with medical and mental health professionals. Int J Impot Res 2023; 35:323. [PMID: 37069438 DOI: 10.1038/s41443-023-00693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Affiliation(s)
- S E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands
| | - M Özer
- Department of Plastic, Reconstructive and Hand Surgery, BovenIJ Hospital, Amsterdam, The Netherlands
- Plastic and Reconstructive Genital Surgery, V-Klinieken, Leiden/Naarden, The Netherlands
| | - F W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands.
| |
Collapse
|
3
|
Timmermans FW, Ruyssinck L, Mokken SE, Buncamper M, Veen KM, Mullender MG, Claes KEY, Bouman MB, Monstrey S, van de Grift TC. An external validation of a novel predictive algorithm for male nipple areolar positioning: an improvement to current practice through a multicenter endeavor. J Plast Surg Hand Surg 2023; 57:103-108. [PMID: 34743656 DOI: 10.1080/2000656x.2021.1994982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The correct positioning of nipple-areolar complexes (NAC) during gender-affirming mastectomies remains a particular challenge. Recently, a Dutch two-step algorithm was proposed predicting the most ideal NAC-position derived from a large cisgender male cohort. We aimed to externally validate this algorithm in a Belgian cohort. The Belgian validation cohort consisted of cisgender men. Based on patient-specific anthropometry, the algorithm predicts nipple-nipple distance (NN) and sternal-notch-to-nipple distance (SNN). Predictions were externally validated using the performance measures: R2-value, means squared error (MSE) and mean absolute percentage error (MAPE). Additionally, data were collected from a Belgian and Dutch cohort of transgender men having undergone mastectomy with free nipple grafts. The observed and predicted NN and SNN were compared and the inter-center variability was assessed. A total of 51 Belgian cisgender and 25 transgender men were included, as well as 150 Dutch cisgender and 96 transgender men. Respectively, the performance measures (R2-value, MSE and MAPE) for NN were 0.315, 2.35 (95%CI:0-6.9), 4.9% (95%CI:3.8-6.1) and 0.423, 1.51 (95%CI:0-4.02), 4.73%(95%CI:3.7-5.7) for SNN. When applying the algorithm to both transgender cohorts, the predicted SNN was larger in both Dutch (17.1measured(±1.7) vs. 18.7predicted(±1.4), p= <0.001) and Belgian (16.2measured(±1.8) vs. 18.4predicted(±1.5), p= <0.001) cohorts, whereas NN was too long in the Belgian (22.0measured(±2.6) vs. 21.2predicted(±1.6), p = 0.025) and too short in the Dutch cohort (19.8measured(±1.8) vs. 20.7predicted(±1.9), p = 0.001). Both models performed well in external validation. This indicates that this two-step algorithm provides a reproducible and accurate clinical tool in determining the most ideal patient-tailored NAC-position in transgender men seeking gender-affirming chest surgery.
Collapse
Affiliation(s)
- Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Laure Ruyssinck
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Sterre E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Marlon Buncamper
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Karel E Y Claes
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Stanislas Monstrey
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Timotheus C van de Grift
- Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Timmermans FW, Elfering L, Steensma TD, Bouman MB, van der Sluis WB. Mastectomy is a safe procedure in transgender men with a history of breast reduction. J Plast Surg Hand Surg 2023; 57:483-487. [PMID: 36621980 DOI: 10.1080/2000656x.2022.2164293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Little is known about the safety and surgical outcomes of mastectomy after breast reduction in the trans male population. Several concerns have been voiced that performing mastectomy with prior breast reduction surgery, increases the risk for complications and revision surgery. All transgender men with a history of breast reduction, who underwent a mastectomy at our center between 01-1990 and 01-2021 were identified from our hospital registry. A retrospective chart study was conducted recording surgical characteristics, surgical complications, revision surgery, and clinical follow-up. A total of 1362 subcutaneous mastectomies were performed between 01-1990 and 01-2021. A total of 36 (2.6%) individuals were included (35 bilateral and 1 unilateral breast reduction). The mean age at mastectomy was 37 ± 10 years, and the median time between breast reduction and mastectomy was 6.3 years (range 1.0-31.1). Most individuals underwent a Wise-pattern breast reduction (91%) and a double incision mastectomy with free nipple grafts (86%). Following mastectomy, one acute reoperation was performed because of hemorrhage (3%). Partial pedicled nipple necrosis was seen in 7% and (partial) non-take of nipple grafts in 4%. Scar revisions were performed in 9%, dogear corrections in 20%, and both nipple corrections, and contour corrections in 6%. When comparing the outcomes in literature for surgical complications, scar revision, contour correction or nipple areolar complex revision, no clear disadvantage seems to be present when performing mastectomy after breast reduction. Mastectomy is a safe procedure in transgender men with a history of breast reduction.
Collapse
Affiliation(s)
- Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Amsterdam Movement Sciences Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Lian Elfering
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Amsterdam Movement Sciences Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Timmermans FW, Mokken SE, Smit JM, Bouman MB, van de Grift TC, Mullender MG, Middelkoop E. The Impact of Incisional Negative Pressure Wound on Scar Quality and Patient Reported Outcomes: a Within-Patient Controlled, Randomized Trial. Wound Repair Regen 2022; 30:210-221. [PMID: 35146830 PMCID: PMC9306814 DOI: 10.1111/wrr.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
Literature provides a moderate level of evidence for the beneficial effects of incisional negative pressure wound therapy (iNPWT) on scar quality. The purpose of this study was to establish if iNPWT results in improved scar outcomes in comparison to the standard of care. Therefore, a within‐patient randomised controlled, open‐label trial was conducted in transgender men undergoing gender‐affirming mastectomies. A unilateral side was randomised to receive iNPWT (PICO™, Smith&Nephew) without suction drains and contrastingly the standard dressing (Steri‐Strips™) with suction drain. Scar quality and questionnaires were bilaterally measured by means of objective assessments and patient‐reported outcome measures (PROM) at 1, 3 and 12 months. Objective scar outcomes were scar pliability (Cutometer®), colouration (DSM‐II) and scar width (3‐D imaging). PROM outcomes were related to scars (POSAS and SCAR‐Q) and body satisfaction (BODY‐Q). From 85 included patients, 80 were included for analyses. No significant difference between treatments was seen in the quantitative outcomes of scar pliability, colour, and width. For qualitative scar outcomes, several significant findings for iNPWT were found for several subscales of the POSAS, SCAR‐Q, and BODY‐Q. These effects could not be substantiated with linear mixed‐model regression, signifying no statically more favourable outcome for either treatment option. In conclusion, this study demonstrated that some PROM outcomes were more favourable for the iNPWT compared to standard treatment. In contrast, the quantitative outcomes showed no beneficial effects of iNPWT on scar outcomes. This suggests that iNPWT is of little benefit as a scar‐improving therapy.
Collapse
Affiliation(s)
- F W Timmermans
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - S E Mokken
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - J M Smit
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - M B Bouman
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - T C van de Grift
- Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - M G Mullender
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - E Middelkoop
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Red Cross Hospital, Vondellaan 13, Beverwijk, the Netherlands
| |
Collapse
|
6
|
van den Heuvel SCM, Timmermans FW, Harmsen THS, van Royen BJ, Winters HAH. Patient-Reported Long-Term Outcomes After Free Vascularized Fibula Graft in Spinal Reconstruction: a 24-year Cohort. J Plast Reconstr Aesthet Surg 2021; 75:629-640. [PMID: 34736853 DOI: 10.1016/j.bjps.2021.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/19/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The use of free vascularized fibula grafts (FVFG) in complex spinal deformity surgery intends to allow for life-long stability of the spine with good long-term clinical outcome. However, these long-term outcomes of this technique are still lacking. The objective of this study is to report the long-term postoperative outcomes and establish the long-term viability of this method for spinal reconstruction. METHODS A retrospective cohort study was conducted in all patients who underwent spinal reconstructive surgery utilizing a FVFG at a tertiary medical centre. Questionnaires taken from the participants were the Numeric Pain Rating Scale (NPRS), Oswestry Low Back Pain Disability (also known as Oswestry Disability Index (ODI)), Scoliosis Research Society 22r (SRS-22), the EQ-5D-5L and a self-assembled questionnaire regarding donor site comorbidities and patient satisfaction. RESULTS Over a period of 24 years (1995-2019), we used FVFG for spinal reconstruction in 31 patients. A total of 25 patients were included in this study, 8 patients were deceased at the time of this study, and sixteen patients responded to the questionnaires. Patient satisfaction was rated 6.8 out of 10, the average SRS-22r score was 3.6, EQ-5D-5L score was 0.725, and the ODI score showed a minimal disability (0-20%) postoperatively. Overall complication-free survival was 8.9 years. Nine patients underwent a re-operation in the spinal area; five for the removal of the spinal instrumentation. CONCLUSION Patients reported satisfied and good long-term outcomes following FVFG surgical procedure for complex spinal deformities. Therefore, considering the alternatives, this procedure provides a good long-term solution for complex spinal deformity surgery.
Collapse
Affiliation(s)
- S C M van den Heuvel
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.
| | - F W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - T H S Harmsen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - B J van Royen
- Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Elfering L, van de Grift TC, Al-Tamimi M, Timmermans FW, de Haseth KB, Pigot GLS, Lissenberg-Witte BI, Bouman MB, Mullender MG. How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons. Sex Med 2021; 9:100413. [PMID: 34425361 PMCID: PMC8498953 DOI: 10.1016/j.esxm.2021.100413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tactile and erogenous sensitivity of the neophallus after phalloplasty is assumed to affect the sexual well-being of transmasculine persons and, ultimately, their quality of life. The experienced and objective sensation of the neophallus and their association are largely unknown. AIM This study evaluated experienced tactile and erotic sensation of the neophallus in transmasculine persons and investigated how this was related to objective tactile sensitivity. METHODS Between August 2017 and January 2020, 59 transmasculine persons who underwent phalloplasty were recruited to participate in a prospective follow-up study. Tactile sensitivity of the neophallus and donor-site was measured (Semmes-Weinstein Monofilament test) and compared, and participants were asked to fill out a questionnaire about experienced sensation of the neophallus and sexual wellbeing. MAIN OUTCOME MEASURES Experienced and objective sensation of the neophallus were measured by using a questionnaire and Semmes-Weinstein Monofilament scores. RESULTS Neophallic tactile sensitivity was significantly reduced compared to the donor-site (n = 44), with the proximal part being more sensitive than the distal part (median follow-up of 1.8 years, range 1.0-7.2)). Sensitivity of the neophallus was not significantly associated with the surgical flap used, yet increased significantly with follow-up time. The questionnaire was completed by 26 participants of which 24 (92.3%) experienced (some degree of) tactile sensitivity in their neophallus. Erogenous sensation was experienced by 23 (88.5%). Experienced and objectified tactile sensitivity were not significantly correlated (Spearmans's rho = 0.23, P = .26). Answers to open-ended questions showed that results often do not match expectations. CONCLUSION Tactile sensation of the neophallus was reduced in most transmasculine persons and improved slowly over time. A significant association between subjective and objective measures could not be detected. Although experienced sensitivity varied between individuals, the vast majority reported to have tactile and erotic sensitivity in the neophallus.Transmasculine persons should be informed that sensitivity of the neophallus will likely be reduced. Elfering L, van de Grift TC, Al-Tamimi M, et al. How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons. Sex Med 2021;9:100413.
Collapse
Affiliation(s)
- Lian Elfering
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands; Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
| | - Muhammed Al-Tamimi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kristin B de Haseth
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Garry L S Pigot
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Timmermans FW, Mokken SE, Smit JM, Zwanenburg PR, van Hout N, Bouman MB, Middelkoop E, Mullender MG. Within-patient randomized clinical trial comparing incisional negative-pressure wound therapy with suction drains in gender-affirming mastectomies. Br J Surg 2021; 108:925-933. [PMID: 34244715 PMCID: PMC10364878 DOI: 10.1093/bjs/znab204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Incisional negative-pressure wound therapy (iNPWT) is widely adopted by different disciplines for multiple indications. Questions about the most appropriate uses and value of iNPWT have been raised. METHODS An open-label within-patient RCT was conducted in transgender men undergoing gender-affirming mastectomies. The objective was to determine the effect of iNPWT as a substitute for standard dressing and suction drains on wound healing complications. One chest side was randomized to receive the iNPWT intervention, and the other to standard dressing with suction drain. The primary endpoints were wound healing complications (haematoma, seroma, infection, and dehiscence) after three months. Additional outcomes were pain according to a numerical rating scale and patient satisfaction one week after surgery. RESULTS Eighty-five patients were included, of whom 81 received both the iNPWT and standard treatment. Drain removal criteria were met within 24 h in 95 per cent of the patients. No significant decrease in wound healing complications was registered on the iNPWT side, but the seroma rate was significantly increased. In contrast, patients experienced both significantly less pain and increased comfort on the iNPWT side. No medical device-related adverse events were registered. CONCLUSION Substituting short-term suction drains with iNPWT in gender-affirming mastectomies increased the seroma rates and did not decrease the amount of wound healing complications. Registration number: NTR7412 (Netherlands Trial Register).
Collapse
Affiliation(s)
- F W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - P R Zwanenburg
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - N van Hout
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - E Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
9
|
Sijben I, Timmermans FW, Lapid O, Bouman MB, van der Sluis WB. Long-term Follow-up and Trends in Breast Augmentation in 527 Transgender Women and Nonbinary Individuals: A 30-year experience in Amsterdam. J Plast Reconstr Aesthet Surg 2021; 74:3158-3167. [PMID: 34020905 DOI: 10.1016/j.bjps.2021.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transgender women and transfeminine spectrum nonbinary individuals may opt for breast augmentation. The aim of the study is to analyze the complications, surgical trends, and long-term follow-up of breast augmentations in this population over the past 30 years. METHODS All transgender women and nonbinary individuals who underwent breast augmentation at our center between 01-1990 and 01-2020 were retrospectively identified. A retrospective chart study was conducted, recording individual demographics, implant characteristics, surgical timing, postoperative complications or other reasons requiring reoperation, and implant survival. A literature search was performed in MEDLINE on clinical outcomes and revision surgery of this procedure. RESULTS A total of 527 individuals were identified. Median clinical follow-up time was 11.2 years (interquartile range 3.3-17.5). Median implant size increased significantly over the last years (1990-1990 median 275cc, 2000-2009 252cc, 2010-2019 375cc, p<0.01). Most individuals underwent breast augmentation and genital gender-affirming surgery in one-stage. Reoperations due to short-term complications were infrequent (hematoma (0.4%) or infection (0.4%)). Reoperations due to long-term complications comprised: implant rupture (5.7%), capsular contracture (4.9%), aesthetic problems (3.8%), low-grade infection (0.4%), or seroma (0.6%). In total, 2.5% of individuals requested larger implants. After performing the literature search and manuscript screening, 9 out of 115 identified studies were included for review. Follow-up time ranged from 30 days to 5.5 years. Reported complications requiring reoperation were capsular contraction (range 0.0-5.6%), asymmetry (3.6%), hematoma (range 0.0-2.9%), infection (range 0.0-0.9%) and implant rupture (0.7%), CONCLUSION: Implant-based breast augmentation is a safe procedure in transgender individuals.
Collapse
Affiliation(s)
- Isha Sijben
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Floyd W Timmermans
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Mark-Bram Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Wouter B van der Sluis
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands.
| |
Collapse
|
10
|
de Blok CJM, Dijkman BAM, Wiepjes CM, Staphorsius AS, Timmermans FW, Smit JM, Dreijerink KMA, den Heijer M. Sustained Breast Development and Breast Anthropometric Changes in 3 Years of Gender-Affirming Hormone Treatment. J Clin Endocrinol Metab 2021; 106:e782-e790. [PMID: 33206172 DOI: 10.1210/clinem/dgaa841] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Breast development is important for most trans women. An important limitation of current breast development measurement methods is that these do not allow for 3D volume analyses. OBJECTIVES To examine breast development and change in anthropometry during the first 3 years of gender-affirming hormone treatment using 3D imaging. Associations with clinical or laboratory parameters and satisfaction with the gained breast development were also studied. DESIGN Prospective cohort study. SETTING Specialized tertiary gender identity clinic in Amsterdam, the Netherlands. PARTICIPANTS Participants were 69 adult trans women with a median age of 26 years (interquartile range, 21-38). INTERVENTIONS Gender-affirming hormone treatment. MAIN OUTCOME MEASURES Volumetric and anthropometric breast development and satisfaction. RESULTS Breast volume increased by 72 cc (95% confidence interval [CI], 48-97) to 100 cc (standard deviation 48). This resulted in a cup-size <A-cup in 71% of the participants. Although the change in breast-chest difference plateaued after approximately 9 months, sustained increase in breast volume was observed during the 3-year observation period. Sternal notch to nipple distance increased by 1.3 cm (95% CI, 0.9-1.7) and internipple distance increased by 1.0 cm (95% CI, 0.4-1.5). At least 58% of trans women were satisfied with the gained breast size. CONCLUSIONS Sustained breast growth and development during hormone treatment was observed during the full 3-year observation period. The breasts of trans women are positioned more laterally and caudally on the chest compared with cis women. Although modest breast volumes were observed, breast development was satisfactory to most trans women.
Collapse
Affiliation(s)
- Christel J M de Blok
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
| | - Benthe A M Dijkman
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
| | - Chantal M Wiepjes
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
| | - Annemieke S Staphorsius
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
| | - Floyd W Timmermans
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, HV, Amsterdam, the Netherlands
| | - Jan Maerten Smit
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, HV, Amsterdam, the Netherlands
| | - Koen M A Dreijerink
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, HV, Amsterdam, the Netherlands
| |
Collapse
|
11
|
Zwanenburg PR, Timmermans FW, Timmer AS, Middelkoop E, Tol BT, Lapid O, Obdeijn MC, Gans SL, Boermeester MA. A systematic review evaluating the influence of incisional Negative Pressure Wound Therapy on scarring. Wound Repair Regen 2020; 29:8-19. [PMID: 32789902 PMCID: PMC7891404 DOI: 10.1111/wrr.12858] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
Pathological scars can result in functional impairment, disfigurement, a psychological burden, itch, and even chronic pain. We conducted a systematic review to investigate the influence of incisional Negative Pressure Wound Therapy (iNPWT) on scarring. PubMed, EMBASE and CINAHL were searched for preclinical and clinical comparative studies that investigated the influence of iNPWT on scarring‐related outcomes. Individual studies were assessed using the OHAT Risk of Bias Rating Tool for Human and Animal studies. The body of evidence was rated using OHAT methodology. Six preclinical studies and nine clinical studies (377 patients) were identified. Preclinical studies suggested that iNPWT reduced lateral tension on incisions, increased wound strength, and reduced scar width upon histological assessment. Two clinical studies reported improved patient‐reported scar satisfaction as measured with the PSAS (1 year after surgery), POSAS, and a VAS (both 42, 90, and 180 days after surgery). Five clinical studies reported improved observer‐reported scar satisfaction as measured with the VSS, SBSES, OSAS, MSS, VAS, and POSAS (7, 15, 30, 42, 90, 180, and 365 days after surgery). Three clinical studies did not detect significant differences at any point in time (POSAS, VAS, and NRS). Because of imprecision concerns, a moderate level of evidence was identified using OHAT methodology. Preclinical as well as clinical evidence indicates a beneficial influence of iNPWT on scarring. Moderate level evidence indicates that iNPWT decreases scar width and improves patient and observer‐reported scar satisfaction.
Collapse
Affiliation(s)
- Pieter R Zwanenburg
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection & Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Floyd W Timmermans
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Allard S Timmer
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection & Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands
| | - Berend T Tol
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection & Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Miryam C Obdeijn
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sarah L Gans
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection & Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection & Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
12
|
van der Sluis WB, Steensma TD, Timmermans FW, Smit JM, de Haseth K, Özer M, Bouman MB. Gender-Confirming Vulvoplasty in Transgender Women in the Netherlands: Incidence, Motivation Analysis, and Surgical Outcomes. J Sex Med 2020; 17:1566-1573. [DOI: 10.1016/j.jsxm.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
|
13
|
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Collapse
Affiliation(s)
- M Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands. .,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands.,Amsterdam Movement Sciences Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Özer M, Timmermans FW. 'An insight into circumcised men seeking foreskin reconstruction: a prospective cohort study'. Int J Impot Res 2020; 32:611-616. [PMID: 31896833 DOI: 10.1038/s41443-019-0223-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 11/09/2022]
Abstract
The aim of this study was to present a cohort of men seeking assistance with foreskin reconstruction, with the objective to broaden the general understanding for this specific request. All men between January 2015 and May 2019 seeking assistance with foreskin reconstruction were included. We prospectively collected data on patient demographics and outcomes such as their motivations, treatment trajectory, and experiences. A total of 11 patients were identified and included (age range 20-62). The majority were circumcised during adulthood for medical reasons. Among the most prominent motivations to pursue reconstruction were experiencing impairment of body integrity, feeling mutilated, increasing glans sensitivity and having issues with an imposed cultural or religious identity. Most patients stated that they experienced little support from healthcare professionals and that the Internet was their main source of information. Furthermore, almost all patients practiced penile tissue stretching to reconstruct the foreskin with unregistered devices. Foreskin reconstruction is a scarcely reported topic and is sought out for different reasons. Although rare, these patients experience a heavy burden and will go to great lengths to reconstruct their foreskin, more often so without the involvement of healthcare professions. In contrary to the surgical treatment options, the nonsurgical methods seem promising, but these rely heavily on lay-sources found online.
Collapse
Affiliation(s)
- M Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands. .,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Amsterdam Movement Sciences Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|