For most of my 30 years in practice I have been interested in genitourinary reconstruction. I was faced with a problem early in my career that consisted of a young married man who lost his penis to flesh-eating bacteria after a circumcision. As a microsurgeon, I was asked to come up with a one-stage reconstruction of penis and urethra. I designed a flap, based on the forearm that actually folded on itself and called it the ‘cricket bat flap.’ The handle portion folded in, and was tubed to form the urethra, while the wider ‘blade’ portion wrapped around the urethra to form the skin on the outside of the new penis. Blood vessels were reconnected to restore circulation and nerves reattached to provide sensory recovery. The use of this construct with penile implants enabled the individual to subsequently father a child!
Since then, I have been able to use this technique successfully on a number of female to male transsexuals (FTM), men who have had penis amputations for cancer and patients with various posttraumatic defects. The flap can be modified in design to deal with partial defects of the penis of defects of the penile urethra.