After a scalped injury to the penis, a burn with significant loss (necrosis) of the skin, removal of an abscess or excision of tissues in case of elephantiasis of the penis, phalloplasty with skin replacement is required, for which the classical technique of autodermoplasty is used. In this case, both pedunculated skin flaps (from the scrotum, lower abdomen or inner thigh) and free skin grafts are used: in the form of split-thickness flaps from the inner surface of the thigh and full-thickness flaps taken from the inguinal region. The flap is attached with interrupted absorbable sutures and covered with a support bandage; the area where the skin was taken is closed with an occlusive or vacuum dressing.
In phalloplasty, performed in cases of hypospadias, the penis shaft is straightened; adjust the lumen of the urethra, passing in the penis; the external opening of the urethra (urinary meatus) is moved to the apical point of the head; skin defects are closed with an autograft.
In case of penis curvature due to fibrous changes in its albuginea (tunika albuginea), the technique of flap plastic surgery of the body of the penis (corpus penis) is used - corporoplasty, plastic with transverse plication, shortening of t. Albuginea on the contralateral side. All the details are in the publication Peyronie's Disease .
The material for the new penis in total phalloplasty is:
- free radial skin flap of the forearm (with a thin dermis, an optimal layer of subcutaneous adipose tissue and sufficient innervation); blood vessels and nerves are sutured using microsurgery; the urethra for urination while standing is formed simultaneously - by the tube inside the tube method;
- skin flap (with legs) of the anterolateral part of the thigh - without blood vessels and nerves (the urethra for standing urination can be formed and a penile implant placed);
- a rectangular skin flap from the suprapubic part of the abdominal cavity (without the urethra passing through the neophallus, that is, urination is performed in a sitting position);
- free flap of the musculocutaneous latissimus dorsi (musculocutaneous latissimus dorsi) with thoracic vessels and thoracodorsal nerve.
Total phalloplasty is performed in several stages; first, a skin graft is taken with the appropriate treatment and a new penis is formed, which is transferred to the pubis and sewn into the incision made. During the female to male operation, the urethra can either be left in its native position, or brought out (in the form of a perineal urostomy), or lengthened to the base of the penis by the tissues of the labia minora.
At the donor site (the place where the flap was taken), dermoplasty is performed with a split skin flap. For the outflow of urine, a Foley urethral catheter is placed, the sewn graft is lifted a few centimeters from the abdominal wall with a special bandage.
At the following stages, the formation of the head of the penis, the restoration or creation of the scrotum (scrotoplasty), the newly created urethra is connected to the bladder; the last stage is the placement of the penis prosthesis and testicles. Of course, this is not all done in one operation: at least three months pass between the stages, and a complete phalloplasty can take up to two years.
Phalloplasty with prosthetics
For additional density and axial stability of the neophallus stem formed from a skin autograft, phalloplasty with prosthetics is performed, which is the implantation of a penis endoprosthesis during a separate surgical intervention. 
Two types of penile prostheses can be used: semi-rigid rod devices and inflatable devices. The first type is a silicone rod with a flexible but rigid core; rigidity does not allow "transferring" neopenis to a relaxed state and, moreover, constant pressure on the skin, leading to erosion.
The basis of hydraulic inflatable penile prostheses are inflatable cylindrical chambers (placed in the reconstructed penis), a pump (implanted in the scrotum and actuated by hand compression) and a fluid-filled reservoir (which is sewn into the abdominal cavity).