John Bloem

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Female transsexuals accepted for surgical reassignment usually choose breast removal to achieve a male chest configuration as their first operation, thus facilitating the adjustment to a male lifestyle. At the Academic Hospital of the Free University (Amsterdam, The Netherlands), usually one of three techniques is applied for a subcutaneous mastectomy. We(More)
Even after opening the carpal tunnel for median nerve compression 25 percent of patients have persistent symptoms, the so-called post-carpal tunnel syndrome. Analysis of 135 median nerve decompressions carried out for primary carpal tunnel syndrome showed flexor tenosynovitis in the flexor sheaths of the fingers and operation scarring to be the main causes.(More)
In 23 cadaveric hands the hypothenar region was studied and this report is about the anatomical boundaries and contents of Guyon's Canal. It was noted that the contents of Guyon's canal exit through two distinct areas termed the deep distal hiatus and superficial distal hiatus. A variation in the course of the deep branch of the ulnar artery, reported to be(More)
For lengthening of the urethra in female-to-male transsexuals, an anterior vaginal wall flap is used. This flap is separated from the posterior urethral wall down to the attachment at the urethral meatus following a glistening cleavage plane. In this paper we present the anatomic and histologic basis of this flap. Prior to this, the relevant vaginal anatomy(More)
Although the surgical goals of phalloplasty in female-to-male transsexuals have repeatedly been described, the requests by the patients themselves have never been assessed and evaluated properly. To obtain information on their desiderata in this matter a questionnaire was sent to 200 subjects. The answers in the 150 returned questionnaires made us conclude(More)
In phalloplasty, the use of transplants and implants to obtain sufficient rigidity allowing for sexual penetration is difficult and often has resulted in complications and failure. Resorption, curving, and fracture of autologous cartilage and bone transplants are reported, and rigid implants have a tendency to erode and extrude. Besides, a constantly rigid(More)
Genital construction in female-to-male transsexuals also should involve giving the labial region a scrotum-like appearance. A review of the literature on this subject is given. In our hospital, the construction of a scrotum in which testicular prostheses are implanted has been performed usually in combination with lengthening of the pars fixa of the(More)
Genital construction in female-to-male transsexuals should ideally involve the creation of a competent neourethra, allowing the patients to void while standing. A short review of the literature on this subject is given. In our hospital, construction of the fixed part of the urethra up to the level of the clitoris has been accomplished using an anterior(More)
We devised a technique for phalloplasty in a female-to-male transsexual combining the lateral upper arm free flap with a bladder mucosa graft, to address the ideal requirements of phalloplasty in the best possible way. The surgical techniques are described. Healing of the phallus has been uneventful, but postoperative bladder spasms, meatal stenosis, and an(More)