Pedicled superficial circumflex iliac artery perforator flap for male genital reconstruction: A case series

Abstract

Background: Different issues may cause defects in the genital region, including urological, infective, oncological and genetic problems which often lead to significant defects. This is a very delicate region and a successful coverage requires a thin, pliable and reliable solution. In this setting the SCIP flap might be an outstanding procedure. Despite being a well-known solution in the groin region, its employment for genital reconstructions is still poorly described. For this reason, we gather our experience with this procedure showing the efficacy of the SCIP flap in this specific region.Patients and Methods: In the present case series we included 6 male patients who received a soft tissue defect reconstruction by means of pedicled SCIP flap over the last year. The average age was 53.6 years old (range 34-79 years). Among them, 5 patients received a surgical excision because of severe acne (2 cases), Fournier's gangrene (2 cases), or scrotal squamous cell carcinoma (1 case). In 1 case the cause of the missing volume was testicle agenesis and the reconstruction was performed for cosmetic purposes. Size of the defects ranged from 7 cm  4 cm to 20 cm  6 cm. Elliptical shaped flaps were designed either mono-or bilaterally according to the need. All the flaps were supplied by the superficial branch of the SCIA. The range of rotation varied between 150 and 180 in order to reach the affected area. Results:The flaps' dimension ranged from 8 cm  4 cm to 20 cm  6 cm. All the patients were successfully treated. In 1 case we encountered a small wound dehiscence, which was managed conservatively. The mean follow-up was 9.5 months (range 6-12 months). Good cosmetic result was achieved in all cases and no urinary or sexual dysfunctions were reported. Conclusions:The pedicle SCIP flap represents a reliable solution for genital and inguinal defects reconstructions. Its versatility can be exploited throughout the region providing very good quality tissues that can be used for the most disparate situations. | INTRODUCTIONSoft tissue defects in the genital area represent a delicate and critical issue that plastic surgeons may encounter rather often during their practice. The underlying causes may be heterogeneous ranging from trauma, to infection, to congenital problems, such as in case of testicle agenesis (Garaffa et al., 2011;Rosevear et al., 2009). Other common examples that require a genital soft tissue resection are tumors (Bickell et al., 2016), Fournier's gangrene (Lee et al., 2007, extramammary Paget's disease (Lee et al., 2007), and unfortunately Mario F. Scaglioni and Matteo should be considered first co-authors.

Reconstruction of Acquired Defects of the External Genitalia

“…Knowing this, it is reasonable to conclude that the perforator group is a favorable flap, in the case of those who have undergone irradiation before ablation and reconstruction. Their minimal complication rate, flexibility, distance from direct radiation, and historic success underscore these results 12,21 …”

“…Their minimal complication rate, flexibility, distance from direct radiation, and historic success underscore these results. 12,21 When selecting the islandized regional PF, it is important to weigh the increased operative time against the benefits it may offer over the faster local flap option. Our results demonstrate this prolonged surgical time to a statistically significant degree.…”

“…1-3). 12 There is a dearth of literature directly comparing outcomes of local tissue flaps to islandized PFs in genital reconstruction. The aim of our study is to analyze the outcomes of a single institution's approach to external genital reconstruction and compare local tissue flaps to islandized PFs as options in the reconstructive armamentarium.…”

Combination of four pedicled flaps for multilayer reconstruction of massive pelvic defect: A case report

“…The ALT flap is a very versatile solution as it allows chimeric forms that might include muscle, fascia, and nerves (Scaglioni et al, 2018), and it is usually considered the first choice for groin reconstruction because of its proximity, low donor site morbidity, and long pedicle (Ali et al, 2009). The SCIP flap is another very interesting technique in this region, where it proved its reliability in most different settings, including genital reconstruction (Scaglioni, Meroni, & Fritsche, 2022). It offers a series of interesting features: it is relatively quick to harvest, it can provide either a thin and very pliable amount of tissue or a rather large and thick island, the aesthetic result is usually good, and the donor site morbidity is very low (Chao et al, 2016; Scaglioni, Meroni, Fritsche, & Fuchs, 2022).…”

Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction

“…Options for local flaps in scrotal reconstruction are available in three areas (Table 2): the groin, medial thigh, and lateral thigh. In the groin, superficial circumflex iliac perforator (SCIP) flaps are used [63][64][65][66]. In the superomedial thigh region, gracilis flaps nourished by the medial circumflex femoral artery and perforator flaps of the anterior branch of the obturator artery are selected [67][68][69][70][71].…”