Male external genitals reconstruction following tumor ablation

Abstract

External genital reconstruction following tumor ablation presents reconstructive surgeons a great challenge. Male external genital structures are not easily replaced by extragenital tissues. Recent advances in the design of flaps and the use of microsurgical tissue transfer techniques have remarkably improved the functional and aesthetic results of genital reconstruction.Pseudostratified columnar epithelium within the urethra abuts the stratified squamous epithelium covering the glans penis and the inner surface of the prepuce in men and the clitoris and labia minora in women. This glabrous epithelium is continuous with the nonglabrous skin of the penile and clitoral shaft and the outer layer of the labia minora which are sparsely supplied with hair follicles and other skin appendages. This glabrous epithelial tissue is more likely to incur epithelial dysplasia and metaplasia than is the nonglabrous skin. Carcinomain-situ, known as erythroplasia of Queyrat, is characterized by a circumscribed, velvety, papillary red lesion on the glans penis, coronal sulcus, or inner face of the prepuce and in women, over the labia minora. If untreated, these lesions may progress to superficial ulceration and degenerate into squamous cell carcinoma. The treatment of carcinoma-in-situ is ablation of those cells with malignant potential.Mohs' micrographic surgery (MMS) (Fig.