Penile reconstruction requires separate plans for coverage, urination, sensation and rigidity. The remaining anatomy and the patient's goals determine which components are needed.

In this episode of Plastics in Practice, we review reconstruction after penile tissue loss and gender-affirming options, connecting native tissue preservation, flap selection, urethral design and staged functional goals.

Key takeaways:

• Define the remaining skin, urethra, erectile tissue and neurovascular structures before selecting reconstruction.

• Preserve viable native tissue when possible; suitable acute amputations need urgent assessment for replantation, while selected skin defects may be managed with grafted coverage.

• Distinguish metoidioplasty using native erectile tissue from flap phalloplasty, and balance donor-site thickness, blood supply, sensation and morbidity.

• Make urethral lengthening an explicit decision. A new urinary channel can develop fistula or stricture even when the outer shaft is viable.

• Nerve coaptation can support sensory recovery, but sensation varies and is not guaranteed.

• Plan rigidity separately: a soft tissue flap does not recreate native erectile bodies, and later erectile devices add implant risks and possible revision.

This content is for educational purposes only and is not medical advice.

The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience.

Instagram account: https://www.instagram.com/plasticsinpractice/

Free study guide: https://docs.google.com/document/d/1lhgYYGTSqDcHL7FzUAqFH0gfbreyWovZ/edit

#PenileReconstruction #Phalloplasty #Metoidioplasty #ReconstructiveUrology #PlasticSurgeryEducation

References:

1. European Association of Urology. EAU Guidelines on Urological Trauma. https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines

2. Oregon Health and Science University. Phalloplasty and Metoidioplasty. https://www.ohsu.edu/transgender-health/phalloplasty-and-metoidioplasty

3. Johns Hopkins Medicine. Phalloplasty for Gender Affirmation. https://www.hopkinsmedicine.org/health/expert-qa/phalloplasty-for-gender-affirmation

4. European Association of Urology. EAU Guidelines on Urethral Strictures: Disease Management in Transgender Patients. https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-transgender-patients

Rheumatoid arthritis can threaten tendons, destabilize joints and change the mechanics of the whole hand. Reconstructive planning begins with the cause of lost function.

In this episode of Plastics in Practice, we review the rheumatoid hand, from the inflammatory-arthritis differential and deformity mechanisms to tendon rupture, joint reconstruction and perioperative planning.

Key takeaways:

• Distinguish rheumatoid arthritis from other inflammatory and degenerative conditions using the clinical pattern, systemic findings and imaging.

• Synovitis can weaken joint restraints and damage tendons; the visible finger posture may reflect a deforming force elsewhere in the hand or wrist.

• Separate flexible, reducible deformity with preserved joint surfaces from fixed deformity with advanced destruction before choosing reconstruction.

• New extension loss warrants prompt assessment. Distinguish tendon rupture from tendon subluxation or nerve dysfunction, and address the attritional source when reconstructing a rupture.

• Silicone MCP arthroplasty can improve alignment and patient-reported function without necessarily improving grip or pinch strength.

• Balance the pain, stability and motion goals of wrist reconstruction, and coordinate disease control, medications and perioperative assessment with rheumatology and anesthesia.

This content is for educational purposes only and is not medical advice.

The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience.

Apple Podcasts episode: https://podcasts.apple.com/us/podcast/rheumatoid-arthritis-when-finger-extension-fails/id1835564216?i=1000796831957

Amazon Music episode: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/bb0a03d5-477e-467e-bad9-90fb4dd8837a/plastics-in-practice-resident-review-rheumatoid-arthritis-when-finger-extension-fails

YouTube explainer (recorded human narration): https://www.youtube.com/watch?v=S3Q4n9qksLY

Related YouTube Short: https://www.youtube.com/shorts/hLtLn0a5pgg

Instagram account: https://www.instagram.com/plasticsinpractice/

Free study guide: https://docs.google.com/document/d/1-WAk-57sUaYcorUDKGC98ajLlh4W52Yp/edit

#RheumatoidArthritis #HandSurgery #TendonReconstruction #RheumatoidHand #PlasticSurgeryEducation

References:

1. American Society for Surgery of the Hand. Rheumatoid Arthritis. https://assh.my.site.com/handcare/condition/rheumatoid-arthritis

2. McIntyre et al. Outcomes of Surgical Treatment of Vaughan-Jackson Syndrome. 2024. https://doi.org/10.1055/s-0043-1775994

3. Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study. https://pmc.ncbi.nlm.nih.gov/articles/PMC4852048/

4. Seven-Year Outcomes of the Silicone Arthroplasty in Rheumatoid Arthritis Prospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/27696739/

5. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. https://pmc.ncbi.nlm.nih.gov/articles/PMC9273041/

6. 2022 ACR/AAHKS Perioperative Guideline (elective hip and knee arthroplasty scope). https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.42140

After upper-limb amputation, a surviving nerve can still carry a useful command. TMR gives that signal a new muscle target.

In this episode of Plastics in Practice, we review how targeted muscle reinnervation supports prosthetic control and helps address nerve-related postamputation pain.

Key takeaways:

• Define the goal before choosing transfers: nerve-related pain, prosthetic control, or both.

• TMR connects a residual nerve to a motor branch supplying viable, functionally expendable muscle.

• For motor control, the reinnervated muscle amplifies an intended movement into a signal that surface electrodes can detect.

• Preserve useful native muscle and existing control sites when planning new targets.

• Neuroma-related residual-limb pain and phantom limb pain can coexist and need separate assessment.

• TMR can help reduce nerve-related postamputation pain, but relief is not guaranteed. Pain-directed surgery need not depend on prosthesis use.

• Coordinate surgery, socket fitting and rehabilitation. Better motor signals do not automatically restore sensation.

This content is for educational purposes only and is not medical advice.

The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience.

Editorial clarification at approximately 13:55: The French prospective series compared preemptive TMR with conventional treatment at primary amputation (neuroma burial or simple neurectomy), not with delayed TMR. Mathieu et al., 2025, PMID 39853391: https://pubmed.ncbi.nlm.nih.gov/39853391/

YouTube Short: https://youtube.com/shorts/Vc_3CT2Ysc0

Full video explainer: https://www.youtube.com/watch?v=sUN2KmZDnzA

Instagram account: https://www.instagram.com/plasticsinpractice/

Free study guide: https://drive.google.com/file/d/1_W0mGn-QoVqSUIUXyICkmqJsJwSKzaX1/view

#TargetedMuscleReinnervation #PeripheralNerveSurgery #UpperLimbAmputation #ProstheticRehabilitation #PlasticSurgeryEducation

References:

1. Eberlin et al. A Consensus Approach for Targeted Muscle Reinnervation in Amputees. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10079335/

2. Dumanian et al. Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial. 2019. https://pubmed.ncbi.nlm.nih.gov/30371518/

3. Stubblefield et al. Occupational therapy protocol for amputees with targeted muscle reinnervation. 2009. https://pmc.ncbi.nlm.nih.gov/articles/PMC3031096/