(151) Vacuum-Assisted Closure Therapy to Enhance Skin Graft Take After Radial Forearm Free Flap Phalloplasty: A Preliminary Experience

Introduction Radial forearm free flap phalloplasty (RFFFP) remains the most established technique for penile reconstruction in transgender and gender diverse (TGD) individuals. Raising the flap leaves a substantial soft-tissue defect on the forearm that is resurfaced with a full-thickness skin graft (FTSG) harvested from the lower buttock at our centre. Graft take can be complicated by partial loss, infection, and pain. Vacuum-assisted closure (VAC) therapy has been shown to improve graft integration and cosmetic outcomes in other surgical settings. Objective This study presents preliminary experience using VAC therapy to optimise graft take at the arm donor site following RFFFP. Methods Between April and October 2025, 13 TGD individuals underwent RFFFP with adjunctive VAC therapy applied to the donor arm. In all cases, the FTSG was harvested from the lower buttock. A silicone interface was placed over the graft, followed by sponge dressing and airtight occlusion before initiating negative pressure. The starting pressure ranged from 75 to 125 mmHg and was adjusted based on patient tolerance. Graft take was assessed on postoperative day 5 and weekly thereafter by two specialist nurses, using both photographic and in-person evaluation. Minimum follow-up was 4 weeks. Results Initial VAC pressures were set at 75 mmHg in 4 patients, 100 mmHg in 4, and 125 mmHg in 5. Four patients required a reduction in pressure due to discomfort (one from 100 mmHg, three from 125 mmHg). One patient reported hand pain despite the lowest pressure setting. Sensation was preserved in all except one patient immediately postoperatively; by day 5, 2 reported transient paraesthesia of the thumb. “Pins and needles” sensations were noted in 2 patients on day 1 and in 1 on day 5. At day 5, 2 patients showed <5% graft loss. At four weeks, graft loss was <5% in 3 patients and 10% in 1. Graft take was not influenced by the initial VAC pressure or the need for pressure adjustment. Conclusions VAC therapy appears safe, well-tolerated, and effective in promoting near-complete graft take following RFFFP. Lower suction pressures may enhance comfort without compromising outcomes. These early findings support the feasibility of VAC therapy for donor-site management after phalloplasty, warranting larger comparative studies against conventional dressings to confirm long-term benefits and cost-effectiveness. Disclosure No