Dr. Curtis Crane, MD is a board-certified plastic surgeon who performs Gender Reassignment Surgery procedures in Austin, Texas. Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. He has completed more than 10 years of post-medical school surgical training in urology, reconstructive urology, and plastic surgery.
Optimization of Second-stage Metoidioplasty
Nkiruka Odeluga, Soumya A Reddy, Michael H Safir, Curtis N Crane, Richard A. Santucci. Urology, June 2021.
Metoidioplasty generally requires a planned second-stage to place testes prostheses, address complications, and perform additional surgical steps to maximally lengthen the phallus. We found that phallus length can be optimized in the second-stage by applying surgical principles already established in the surgical treatment of adult acquired buried penis. Escutcheonectomy/penile lift, placement of scrotal implants, repair of chordee, and upper scrotal blocking tissue reduction are procedures that are often performed during a second-stage metoidioplasty.
Planned and Unplanned Delayed Anterolateral Thigh Flap Phalloplasty
Richard A Santucci, Emma R Linder, Galen S Wachtman, Curtis N Crane. Plast Reconstr Surg Glob Open, 2021 Jun 22;9(6):e3654.
Pedicled anterolateral thigh (ALT) flap phalloplasty can be limited by inadequate perfusion. Vascular delay increases perfusion, as delay causes blood vessel formation by limiting the blood supply available to a flap before transfer. We hypothesized that delayed ALT flap phalloplasty would decrease rates of partial flap or phallus loss and other postoperative complications. Planned delay of ALT flaps provided similar results compared with those previously reported by our practice with standard single-stage approach.
Arteriovenous Fistula Rescues Radial Forearm Phalloplasty: A Case Report on Patients with Microvascular Obstruction
Richard A Santucci, Keeley D Newsom, Galen S Wachtman, Curtis N Crane. Plast Reconstr Surg Glob Open, 2021 May 21;9(5):e3595.
Up to 19% of RFF Phalloplasty patients require anastomotic re-exploration. The postoperative creation of an arteriovenous fistula (AVF) to bypass obstruction and salvage RFF Phalloplasties was first reported in 1996. AVF can be reliably used for salvage both intraoperatively and for reintervention. They also suggest that earlier detection of persistent vascular compromise and utilization of AVF can further minimize flap loss.
Trends and Techniques in Gender Affirmation Surgery: Is YouTube an Effective Patient Resource?
Santucci RA, Deleon AN, Crane CN. Plast Reconstr Surg. 2021 May 1;147(5):904e.
Vaginoplasty tips and tricks. [FULL TEXT]
Li JS, Crane CN, Santucci RA. Int Braz J Urol. 2021 Mar-Apr;47(2):263-273.
In this review, we discuss how to achieve satisfactory surgical outcomes with gender-affirming Vaginoplasty, and highlight solutions to common complications involved with the surgery, including: wound separation, vaginal stenosis, hematoma, and rectovaginal fistula. Pre-operative evaluation and standard technique are outlined. Goal outcomes regarding aesthetics, creation of a neocavity, urethral management, labial appearance, vaginal packing and clitoral sizing are all described. Peritoneal vaginoplasty technique and visceral interposition technique are detailed as alternatives to the penile inversion technique in case they are needed to be used. Post-operative patient satisfaction, patient care plans, and solutions to common complications are reviewed.
What urologists need to know about female-to-male genital confirmation surgery (phalloplasty and metoidioplasty): techniques, complications, and how to deal with them. [FULL TEXT]
Jun MS, Crane CN, Santucci RA. Minerva Urol Nefrol. 2020 Feb;72(1):38-48.
This review will discuss the surgical elements behind metoidioplasty and phalloplasty, and the diagnosis and treatment for the most common postoperative issues.
Established and experimental techniques to improve phalloplasty outcomes/optimization of a hypercomplex surgery. [FULL TEXT]
Carter EE, Crane CN, Santucci RA. Plast Aesthet Res 2020;7:33.
In the setting of no established “gold standard”, this review seeks to describe the components and staging of phalloplasty, with an emphasis on established and experimental solutions to the most common and vexing problems.
The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series.
Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, van Moorselaar RJA, Mullender MG, Weigert R, Buncamper ME, Özer M, de Haseth KB, Djordjevic ML, Salgado CJ, Belanger M, Suominen S, Kolehmainen M, Santucci RA, Crane CN, Claes KEY, Monstrey S, Bouman MB. J Sex Med. 2019 Nov;16(11):1849-1859.
In high-volume centers specialized in gender affirming surgery, a secondary phalloplasty in transgender men can be performed after metoidioplasty with complication rates similar to primary phalloplasty.
Phalloplasty with Urethral Lengthening: Addition of a Vascularized Bulbospongiosus Flap from Vaginectomy Reduces Postoperative Urethral Complications.
Massie JP, Morrison SD, Wilson SC, Crane CN, Chen ML. Plast Reconstr Surg. 2017 Oct;140(4):551e-558e.
This study examined the effects of vaginectomy and the addition of extra layers of vascularized vestibular tissue on phalloplasty complication rates. Of 224 total phalloplasty patients, 215 underwent vaginectomy and nine underwent vaginal preservation. Urethral complications occurred in 27 percent of patients with vaginectomy and in 67 percent of patients with vaginal preservation (OR, 0.18; p = 0.02). Vaginectomy was associated with decreased urethral stricture (OR, 0.25; p = 0.047) and urethral fistula formation (OR, 0.13; p = 0.004). Non-urethra-related complications occurred in 15 percent of vaginectomy patients but were not statistically significant (OR, 3.37; p = 0.41). Vaginectomy is associated with a significant decrease in urethral stricture and fistula formation, most likely because vaginectomy affords additional horizontal urethroplasty suture line coverage of labia minora flaps with vascularized vestibular tissue.
Outcomes of Single-Staged Phalloplasty by Pedicled Anterolateral Thigh Flap versus Radial Forearm Free Flap in Gender-Confirming Surgery [FULL TEXT]
Ascha M, Massie JP, Morrison SD, Crane CN, Chen ML. J Urol. 2017 Jul 29.
This study examines outcomes between transmales who had phalloplasty with vaginectomy and full-length urethroplasty utilizing the anterolateral thigh pedicled flap (pALT) or radial forearm free flap (RFFF). There were 213 patients included: 149 RFFF and 64 pALT phalloplasties. RFFF patients had a significantly higher body mass index (BMI) than pALT patients. The overall urethral complication rate for RFFF phalloplasty was 31.5%; the overall pALT rate was 32.8%. The rate of partial or total neophallus loss was 7.8% for pALT and 3.4% for RFFF. Patients in the pALT cohort experienced significantly greater odds of urethral fistula (OR=2.50, p=0.024), non-urethral complications (OR=2.38, p=0.027), and phallus wound dehiscence (OR=5.03, p=0.026). pALT phalloplasty was associated with overall greater odds of urethral and other complications at six months follow-up.
An overview of female-to-male gender-confirming surgery
Morrison SD, Chen ML, Crane CN. Nat Rev Urol. 2017 May 16.
Phalloplasty, with a resultant aesthetic and sensate phallus along with implantable prosthetic, can take upwards of a year to accomplish, and is associated with a considerable risk of complications. Urethral complications are most frequent, and can be addressed with revision procedures. A number of scaffolds, implants, and prostheses are now in development to improve outcomes in FtM patients
Phalloplasty: A Review of Techniques and Outcomes.
Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Plast Reconstr Surg. 2016 Sep;138(3):594-615.
Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes. Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients.
Pre- and Post-operative Care With Associated Intra-operative Techniques for Phalloplasty in Female-to-male Patients
Shane D. Morrison, MD, MS; Marcelina G. Perez; Cayden K. Carter; Curtis N. Crane, MD. Urol Nurs. 2015;35(3):134-138.
The most common techniques for phalloplasty, along with the pre-operative and post-operative care are discussed.