The most widely used TPR technique is a radial forearm free flap (RFFF) described by Song et al in 1982. However the urethrocutaneous fistula rate is up to 40% and the donor site morbidity around 9%. The tissue flap is taken from the inside of the forearm and the defect covered with a skin graft. The flap is fashioned into the shape of a penis and a skin tube created inside to connect to the urethra. This flap may contain radial bone to provide rigidity and enable sexual function. Radial bone harvesting increases the morbidity of the donor site, as the forearm becomes very thin distally. The operation takes around 7 - 10 hours to perform. It provides a phallus which is cosmetically acceptable after tattooing the glans penis, but completely incapable of sexual function without a prosthesis, if bone is not incorporated. In a series of 15 adult female to male gender reassignment patients, only 7 received prostheses, indicating that not all TPRs are suitable to receive a prosthesis.