One-stage reconstruction of the penis

Hester, T. Roderick; Hill, H. Louis; Jurkiewicz, M. J.

doi:10.1016/s0007-1226(78)90110-8

Cited by 31 publications

(3 citation statements)

References 4 publications

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“…The multistage tube flaps are not acceptable by many surgeons today. Gracilis muscle or a myocutaneous flap 5,6 may not be available due to previous failed attempts to use this material, as in our patient. Sometimes the patient's condition is complicated by the effects of previous radiation therapy to the groin.…”

Section: Discussionmentioning

confidence: 91%

One-Stage Penile and Urethral Reconstruction - A New Extension of Inferiorly Based Rectus Abdominis Myocutaneous Flap

et al. 1990

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The loss of a penis, either through trauma or other causes, is psychologically and physiologically intolerable for the victim. The ideal reconstruction should be a reliable single-stage procedure that requires minimum hospitalization and yields acceptable cosmetic and functional results. The traditional techniques, which use tube flaps, are three-to five-stage procedures that are time consuming and physically and economically difficult for the patients. 1The rectus abdominis myocutaneous flap has gained popularity for various reconstructive procedures, including coverage of the groin, 2 thigh, 2 and above-knee amputation stumps. 3 Recently it has been used for vaginal and pelvic reconstruction. 4 We have used an interiorly based rectus abdominis myocutaneous flap to reconstruct an amputated penis and urethra as a single-stage procedure. Surgical ReportA six-year-old boy was referred to our unit for possible reconstruction for his knife-amputated penis, inflicted two years earlier by his psychologically disturbed mother. He was operated on twice at his local hospital, but no details of these attempted procedures were available.Examination revealed absence of the penis, with the urethral opening flush with the scrotum, which was normal (Figure 1). There were irregular scars over the upper medial aspects of both thighs and the groin, suggesting that a gracilis myocutaneous flap had been attempted previously. A micturating cystourethrogram showed a truncated urethra (3 cm), with a short stricture posteriorly.The patient was subsequently operated on using an inferiorly based rectus abdominis myocutaneous flap. At operation a suprapubic puncture cystostomy catheter was first introduced. The right rectus muscle was used as the source of the flap. A vertical skin strip (3 x 12 cm) extending from 3 cm below the xiphoid process to 3 cm below the umbilicus was marked and an incision made down to the anterior rectus sheath, which was incised vertically at the medial and lateral borders of the rectus (Figure 2). This area was then divided at the upper border of the flap and the superior epigastric artery ligated. The whole muscle was freed from the posterior rectus sheath and dissected downward, with the attached skin, care being taken not to injure the inferior epigastric artery.At the level of the inferior border of skin, fascia was separated from the muscle pedicle and the muscle further dissected down. Subcutaneous dissection in the suprapubic area was done and a tunnel was created, through which the flap was rotated and passed underneath to the recipient area (Figure 3). The skin was folded and sutured with interrupted 4-0 chromic catgut to reconstruct the urethra. The proximal end was anastomosed to the urethral opening after appropriate fashioning and a No. 10 Foley catheter was introduced down to the bladder as a stent.The distal end of the skin was folded back dorsally to shape the glans penis (Figure 3). The borders of the rectus were approximated ventrally over the attached skin urethral tube using 3-0 chromic. Th...

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Section: Discussionmentioning

confidence: 91%

One-Stage Penile and Urethral Reconstruction - A New Extension of Inferiorly Based Rectus Abdominis Myocutaneous Flap

et al. 1990

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“…Even at the present time, there are two schools of penile and urethra reconstruction: the classic reconstruction using tubed flaps [3,4,11,12,16,22] requiring a multistage operation, and the one-stage microsurgical reconstruction [1,3,5,6,9,28]. Followers of the classic school emphasize the size of the reconstructed penis, which can be, at least in some cases, really huge [18,22].…”

Section: Resultsmentioning

confidence: 99%

“…Single subcutaneous pedicled infra-umbilical flap Hester et al [12] performed a single-stage penile reconstruction with the infra-umbilical flap using a vertically located branch of the superficial inferior epigastric vessels in a subcutaneous pedicle. As opposed to the previous infra-umbilical flaps, the pedicle was not formed by the cutaneous tissue of the flap, but only by the subcutaneous tissue, incorporating the vessels running laterally from the midline.…”

Section: Introductionmentioning

confidence: 99%

A variety of methods for penile reconstruction

Veselý

Stupka

Molitor

et al. 2002

European Journal of Plastic Surgery

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The authors have used microsurgical methods for one-stage phalloplasty in 63 penile reconstructions performed over the past 12 years. These operations account for about 10% of the free tissue microsurgical transfers performed in their clinic. Usually a one-stage microsurgical phalloplasty is performed using a combination of the techniques of Biemer, Trengove-Jones, and Gilbert together with the author's own way of sculpturing the glans. Several nontypical methods using multiple flap combinations were used in collaboration with Santi and Berrino in the Instituto Nazionale per la Ricerca sul Canro, Genoa (Italy) and Dominici and Pacifici at the University of Perugia (Italy). The authors were responsible for the idea of constructing a skin tunnel inside the penis using two microsurgical free flaps which allows insertion of a temporary inner stiffener. From the microsurgical point of view, this procedure should be considered a "flap within a flap."

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The evolution of transgender surgery

et al. 2018

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An estimated 1.4% of the population worldwide has been diagnosed with Gender Dysphoria, as defined by the Diagnostic and Statistical Manual of Mental Disorders. Gender reassignment, which holistically encompasses psychotherapy, hormonal therapy and genital and nongenital surgeries, is considered the most effective treatment for transgender nonconforming patients afflicted with gender dysphoria. Little research is currently available identifying the psychosocial needs of the transgender population and their access to preventative and primary care during this transitioning process. This article presents an overview of the evolution and current approaches to genital surgical procedures available for both male-to-female, as well as female-to-male gender-affirmation surgeries. Clin. Anat. 31:878-886, 2018. © 2018 Wiley Periodicals, Inc.

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One-stage reconstruction of the penis

Cited by 31 publications

References 4 publications

One-Stage Penile and Urethral Reconstruction - A New Extension of Inferiorly Based Rectus Abdominis Myocutaneous Flap

One-Stage Penile and Urethral Reconstruction - A New Extension of Inferiorly Based Rectus Abdominis Myocutaneous Flap

A variety of methods for penile reconstruction

The evolution of transgender surgery

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