A Reliable Technique in the Reconstruction of Large Penoscrotal Defect: Internal Pudendal Artery Perforator Flap

ObjectivesTo assess long-term sexual outcome and quality of life after perineal reconstruction by pedicled anterolateral thigh (ALT) flaps after Fournier's gangrene. Postoperative surgical outcomes were assessed; quality of life and sexual function were assessed at long term follow-up (>12 months) with 2 scientifically validated questionnaires.MethodsWe conducted a retrospective analysis of a prospectively maintained database. Long-term sexual function and quality of life were assessed by standardized questionnaires. Descriptive statistics were conducted.Results8 patients were included in our study, 5 patients responded to quality of life and sexual function analysis. Surgical outcomes were in line with literature: one minor complication (minor dehiscence requiring a skin graft), one major complication (flap loss, requiring a second, contralateral flap) occurred. No reconstructive failure occurred. Average time to complete wound healing was 17 days (SD ±5). Quality of life scores over 70/100 in four out of five categories; social function was rated lowest: patients reported very few residual complaints. Sexual outcome analysis emphasizes the positive impact of the reconstruction. As expected, Fournier's Gangrene heavily affected patient's sexual health.ConclusionsPerineal reconstruction with ALT shows excellent quality of life, and good sexual health outcomes. Currently the lack of reliable and relatable data leads to the impossibility to compare different reconstructive procedures. We emphasize that assessing sexual function and quality of life after perineal reconstruction is paramount to weigh reconstructive success.

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“…Many disadvantages are avoided using local flaps ( 8 , 9 ). Albeit more complex, flap surgery offers ample, stable tissue where needed.…”

Section: Introductionmentioning

confidence: 99%

Quality of life and sexual health after perineal reconstruction in Fournier gangrene using pedicled anterolateral thigh flaps

et al. 2022

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“… *An estimated 61 of 108 studies quantify patients who underwent culture. 4 , 8 , 11 , 12 , 17 , 18 , 20 , 21 , 23 – 25 , 30 , 31 , 34 , 36 – 38 , 41 – 46 , 49 , 50 , 52 , 56 , 57 , 59 , 60 , 63 , 69 , 72 , 76 , 77 , 80 , 82 , 84 – 87 , 89 – 91 , 93 – 96 , 98 – 109 , 111 …”

Section: Resultsmentioning

confidence: 99%

Practical Review of the Current Management of Fournier’s Gangrene

Huayllani

Cheema

McGuire

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“… 12 – 14 , 19 , 20 , 25 , 27 , 30 , 33 , 34 , 37 – 46 The advantages (and disadvantages) of these nonaxial pattern flaps are well known. 12 – 14 , 20 , 25 , 27 , 30 , 33 , 34 , 37 – 46 Their use has been suggested as an ideal option for the reconstruction of moderate to moderate-severe perineal defects that do not cross the midline (eg, semi-vulvar reconstruction), and that do not require the “bulkiness” of more invasive muscle or musculocutaneous flaps (eg, gracilis flap, rectus abdominis muscle flap, etc. ), and that cannot be repaired with minor local techniques.…”

Section: Discussionmentioning

confidence: 99%

Gender-specific Anatomical Distribution of Internal Pudendal Artery Perforator: A Radiographic Study for Perineal Reconstruction

Sonda

Monticelli

Venezia

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Cancer, trauma, infection, or radiation can cause perineal defects. Fasciocutaneous flaps based on perforator vessels (PV) from the internal pudendal artery (IPA) provide an ideal reconstructive option for moderate defects. We hypothesized that, due to gender differences in the pelvic–perineal region, the anatomical distribution of PV differs between genders. Methods: Computed tomography angiographies from male and female patients without pelvic–perineal pathologies were retrospectively analyzed to study the vascular anatomy of the IPA. The number, size, type, and distribution of PV were recorded and compared between genders. Four anatomical regions were defined to describe the distribution of PV on each perineal side: anterior (A), anterior-central (AC), central-posterior (CP), and posterior (P). Results: A total of 63 computed tomography angiographies were analyzed (men, 31; women, 32). Each IPA provides 2 ± 1 PV and 5 ± 2 terminal (cutaneous) branches: in both genders, 85% of PV are septocutaneous (15% musculocutaneous). In women, 70.5% of PV are located in AC, 28.2% in CP, 1.2% in A, and 0% in P: average diameter of the PV is 2.4 ± 0.3 mm. In men, 53.7% of PV are located in CP, 43.1% in AC, 3.3% in A, and 0% in P: average diameter of the PV is 2.8 ± 0.5 mm. Gender-specific differences in anatomical distribution of PV are significant (P < 0.001). Conclusions: Number, size, and type of terminal branches of PV of the IPA are consistent between genders, but their distribution is different, with women having an anterior predominance. Knowledge of gender-specific anatomy can guide preoperative planning and intraoperative dissection in flap-based perineal reconstruction

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A Reliable Technique in the Reconstruction of Large Penoscrotal Defect: Internal Pudendal Artery Perforator Flap

Cited by 11 publications

References 23 publications

Quality of life and sexual health after perineal reconstruction in Fournier gangrene using pedicled anterolateral thigh flaps

Quality of life and sexual health after perineal reconstruction in Fournier gangrene using pedicled anterolateral thigh flaps

Practical Review of the Current Management of Fournier’s Gangrene

Gender-specific Anatomical Distribution of Internal Pudendal Artery Perforator: A Radiographic Study for Perineal Reconstruction

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