A Simple and Step-wise Dissection of the Ilioinguinal Nerve for Gender-Affirming Phalloplasty and Genital Nerve Transfers

Peter Ferrin, Brynn Hathaway, Blair R Peters

The ilioinguinal nerve is one of the main donor nerves used to innervate the penis in phalloplasty surgery and the most common donor nerve used for sensory re-innervation in genital nerve transfers.1 This video demonstrates an anatomic dissection of the ilioinguinal nerve for gender-affirming phalloplasty performed in real-time, illustrating the efficiency of this surgical approach using easily identifiable anatomic landmarks. An incision is made between the mons pubis and the anterior superior iliac spine down to the level of the anterior rectus sheath. The ilioinguinal nerve exits the superficial or external inguinal ring which is located just superior to the pubic tubercle.2 There is always a fascial band overlying the ilioinguinal nerve as it emerges from superficial inguinal ring, which is easily seen and palpated when placed under tension. The inferior skin flap is pulled upwards and inferiorly to create this tension to identify this fascial band. Once found, a finger is used to trace this band proximally and identify the superficial inguinal ring by having the finger “fall into” or “probe” the ring. The pubic tubercle can be palpated immediately inferior to this to confirm correct anatomic location. Blunt dissection is then performed with tenotomy scissors through the fascial band distal to the superficial inguinal ring which will expose the ilioinguinal nerve. The nerve is then dissected proximally and distally for length and can be marked with a vessel loop and clip to allow for ease of identification during the microsurgical portion of the case. The key to this dissection is correct identification of anatomic landmarks and inferior tension. Sufficient tension on the inferior skin flap will allow for proper identification of the fascial band overlying the ilioinguinal nerve and location confirmed with manual finger probing of the superficial inguinal ring.

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1. Krasnoff C, Ferrin P, Peters BR. Donor and Recipient Nerve Axon Counts in Gender-affirming Radial Forearm Phalloplasty: Informing Choice of Nerve Coaptations. Plast Reconstr Surg Glob Open. May 2023;11(5):e4971. doi:10.1097/GOX.0000000000004971

2. Klaassen Z, Marshall E, Tubbs RS, Louis RG, Wartmann CT, Loukas M. Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat. May 2011;24(4):454-61. doi:10.1002/ca.21098