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After Care of Female to Male Sex Reassignment Surgery (FTM SRS)
Stages 3:
This is a Surgical Procedure where a phallus is made using tissue from around the area of the forearm.
This third stage of FTM surgery is about creating a phallus by transplanting tissue taken from around the forearm. In the second stage, the vagina was removed, and the urethra was lengthened, in preparation for the 3rd stage where the urethral tunnel which was being prepared by inserting a skin-wrapped catheter into the forearm. During the third stage the entire urethral material fabricated in the forearm, is ready for harvesting and transfer to the actual and new urethra. The surgeon then harvests the forearm tissue with the urethra and connects it to closed vaginal in the second stages and join the urethra to allow normal urination from the penis. The surgeon then connects the nerve supply in the clitoris with the nerve supply to that of the forearm where the skin for the penis was taken so that the patient can feel the same sexual stimulation at the new phallus, as it had been with the clitoris before. Testicles are also fabricated using the skin and tissue from the labia majora, and made to look like a naturally looking scrotum.
Post-Operative Instructions for FTM Stage 3
| 1. |
The forearm where tissue was taken from in making the phallus will be covered by the transplanted skin harvested from the buttock and will be supported with a splint to prevent it from being moved. The patient should keep the arm in the raised position to prevent swelling of the hand and the fingers. |
| 2. |
There will also be a surgical wound made on the hips, caused by the removal of skin from this area for transplantation and grafting at the raw forearm. The wound will be surgically dressed and packed with gauze as there may be some blood oozing. Wound dressing will be performed as often as necessary until the wound is healed in about 1-2 weeks. |
| 3. |
An incisional wound will be made at the abdomen to obtain blood vessels to supply the newly fabricated phallus. A small rubber drainage tube used for draining blood and lymph fluid is instilled and left under the patient’s abdominal skin and allowed to stay there for about 2-3 days. This abdominal incision is the same as used in the Transabdominal hysterectomy in FTM stage 2. |
| 4. |
The newly created phallus will then be placed at its proper position and location. A specific material is used to keep the new phallus in its proper shape and to protect the blood vessels (connected through micro-surgery) from injury, and maintain a good arterial and venous circulation in the newly created phallus. The patient should keep the body in the proper position that the surgeon and nurse recommends. Unnecessary movements as when changing the body’s position could interfere with good blood circulation especially during the first few days after surgery, which is the most crucial period. Improper blood circulation may cause improper blood flow or congestion, and even abnormal bleeding, blood vessel compression, etc. The nurse - in - charge will check the wound and monitor blood circulation every hour for the first 2 days, in order to detect any possible abnormalities and make referrals to the attending physician so that the appropriate treatment or remedy may be given. |
| 5. |
The patient is allowed to have a soft diet and water as soon as he/she regains full consciousness after the surgical procedure. However, in some cases where post-operative problems are noted, the intake of food or drink is delayed until the patient is observed to be well. |
| 6. |
One to three days after the surgery, the patient may experience some flu-like symptoms as a reaction of the body to the surgery as well as the reduced expansion of the lungs brought about by the surgery. Lung expansion has to be maintained by letting the patient breathe deeply with the assistance of the ventilating device. |
| 7. |
About five days after the surgery, the surgeon will check the surgical wound around the forearm which was the source of the tissue for the phallus. The wound will be covered for more five days. After the wound is completely healed, the stitches are then removed and a splint will removed and start to move and function normally. |
| 8. |
The stitches at the abdomen, groin and the new phallus is usually removed within 7-10 days after the surgery. |
| 9. |
A urine catheter is inserted into the new phallus for 10 days, while allowing wound healing to take place and the patient to urinate normally. After that the catheter split will be inserted to prevent constriction of the urethra. Initially, a short urine catheter is inserted only at the shaft of the penis for about 1-2 weeks. Then a longer catheter is used in place of the short one and left there for 6-12 months to prevent constriction of the urethra where the joining site was made, as it may narrow and cause some problems during urination. At this particular time, the patient must follow carefully the surgeon’s instructions, on the proper care, use and/or replacement of the catheter (if no longer functional). |
| 10. |
Normally, all surgical wounds are completely healed after over 1 month, after which the patient is allowed to take a full bath and resume normal activities. |
| 11. |
At the present, a surgeon inserts a custom made silicone rod into the new phallus to prevent shortening and malposition. So when the wound is completely healed, the silicone will allow the new phallus to retain its shape and keep it as firm as a functioning phallus. However the silicone implant is not designed to make the phallus available for sexual intercourse especially within the 6-8 month period after the surgery. The patient may feel some part of the silicone inside the phallus. In the future, there may be a special kind of silicone implant for the purpose of allowing sexual intercourse to be possible with the fabricated phallus. |
| 12. |
Surgical wounds around the arms and hips will usually be completely healed within 1-2 months after surgery. However hypertrophic or keloid scars may be noted to appear on these healed wounds. With the use of elastic bandage and silicone gel sheets applied to the wound site for the first 3-6 months to prevent the abnomal scar possibility. |
If you have any further questions, please do not hesitate to ask your nurse or surgeon in order to facilitate the most appropriate and effective post operative care for all our FTM patients.
PLASTIC AND RECONSTRUCTIVE SURGERY DEPARTMENT
Yanhee International Hospital
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