#delayed alt

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I just had my stage 2 on Friday, and everything looks great! Bedrest sucks but I can feel myself recovering each day.

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Delayed ALT Phallplasty Stage 1 Update

Special Notes on Mobility and Movement

I still used an ace bandage from week 5 to 12, although I started experimented with using it less and less as time went on. The problem was, my donor site felt like it jiggled when I ran or jumped up and down. I suspect this was due to a lack of adhesion between the flap and my other tissue. It’s ok since flap is going to be transplanted anyway, but it was quite annoying. I felt like my leg could take impact from running or jumping much better when there was compression on the leg.

Week 4: Experimented with training on an empty bar.

Week 6: Jumped back to weight training 4x weekly. I felt unsteady, but I didn’t feel as weak as I would’ve expcted. I had some difficulty reaching depth on my squats due to hip tightness, mostly from sitting around for so long.

6 weeks was the timeline suggested by Dr Crane.

Note that I was working with a powerlifting coach who has training in physiotherapy, so I felt very confident about going back full-swing.

When I started squatting with weights, I was immediately back to 185 lbs for 5 reps. 

Good news for strength athletes: your strength will not melt away due to this surgery.

Bad news for endurance athletes: I was out of breath after 5 reps. My cardiovascular system was shit from moving less during recovery. It took me about 3-4 weeks to build this back up as I started introducing more activities into my life. I’m sure it would’ve come back faster if I ran or did more cardio-specific rehab though.

On the other hand, my bench press shot up because it wasn’t affected at all.

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Delayed ALT Stage 1 Updates

Read previous “Updates” post for week 1.

Week 2-4 post-op

I returned to the Bay Area after 5 days post-op.

I slathered bactitracin all over the darkened areas and the suture sites. Sometimes I felt like those areas have a slightly lower temperature compared to the rest of the flap.

Still lots of Kerlix gauze and ace compression bandages to keep everything wrapped up nicely. I found that I really needed to wrap the ace while my leg is straight to walk properly. When the leg is bent, I end up wrapping too tight, and the quad can’t flex against the bandages well, which made me limp more.

At week 2, I was still walking slowly, and still couldn’t do more than 2 steps of stairs in a hobbling motion. My leg seemed to be healing well though, as the grey skin turned more red, and the general skin colouring came back a bit more.

Above pic was around 8 days post-op. One of my drains was kept in due to higher volume of drainage. Dr Crane said I could take it out myself (it felt very strange to pull out 1′ of tubing out of your leg). I removed it at 10 days post-op.

All throughout my healing process. I felt lousy about not being able to do anything. My source of stress relief, powerlifting, was not feasible, and I didn’t quite know what to do with myself. I was in a place away from friends and family, and I definitely felt the lack of support structure. I didn’t think I’d need it for this “small” prep surgery, but this has been harder than my top surgery or hysterectomy.

By week 3, I started reaching out more to my friends and family. I had a friend who knew I was down, and she insisted I call her everyday/every other day. Our hour-long calls helped immensely, even if we didn’t talk about my surgery at all.

Also around week 3, the red/grey areas started receding the the top layer peeled back to reveal a white/black region (pic 1 below).

Later I learned it was necrosis. From the pictures (pic 2+3 above), Dr Crane wasn’t sure if it was just the epidermis (top layer) tissue loss, or full thickness. He sent me to Dr Satterwhite to check it out, since I live close to the BCSS SF location.

At week 4, I started doing physiotherapy to gain strength and mobility back to my right leg. I missed being active and felt myself stuck with some bad habits from limping around. I now highly recommend it for everyone who has had ALT. I was able to gain my range of motion and muscle strength back much quicker. 

The week after (we’re now at 4 weeks post-op), Dr Satterwhite confirmed it was full-thickness necrosis, but he said we will still be able to use the rest of the flap. He prescribed me a really strong antibiotic cream to keep infections away, and to “soften up the tissue”. I was to apply it 3x daily and to come back 2 weeks later to get the tissue debrided. At least the loss was now contained to the black areas, and all the other parts have sufficient bloodflow.

to be continued...

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New Technique: Delayed ALT Phalloplasty

Had my phallo consultation with Dr. Crane last week, and he mentioned he is going to start implementing a modification to the usual free flap ALT process. 

1st stage: tissue preparation + vaginectomy

need to be in town for 3-4 days

outpatient surgery

a short surgery to prepare the thigh tissue 4-5 months before the big one

divide all blood vessels except the 2 big ones in donor tissue

cut out fat in the little square of donor site, reduce girth

tissue gets used to surviving on less blood supply for 4 to 5 months, reducing chance of flap loss

2nd stage: neo-phallus and neo-urethra creation

need to be in town for 4 weeks, 1 week in hospital

need another person to help for 1 week or 2

10% fistula, 20% stricture rate

3rd stage - glansplasty and implants

need to be in town for 3-4 days

outpatient

Successful on 2 patients so far, Dr. Crane says this may be the way to go for the future of ALT. Logically, it makes sense. However, seeing as how it’s a new technique, I’m going to review the results of it when I’m closer to my own surgery date, at which time I hope he’ll have done many more of them to have better statistics to back it up.

While I was a bit hesitant to go with Dr. Crane before, this new technique of his has definitely intrigued me and I was swayed to go with him instead of Dr. Chen (due to several current malpractice suits, see previous post). At the moment, I think I would be happier with the result from Dr. Crane, because the girth of the ALT phallus is a big concern for me, and I do not want RFF because I have skinny forearms.

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1 day post-op: My leg hurts and peeing is painful. It’s full-on recovery mode as I max out all the pain pills.

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Well, here I go. 7 hrs until surgery. Let's get it.