Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap

Abstract

Background Successful penoscrotal reconstruction requires proper resurfacing of the defect and maintenance of the original shape of the penis and scrotum. We examined the feasibility of using the superficial circumflex iliac artery perforator (SCIP) propeller flap to effectively reconstruct penoscrotal defects. Methods Eleven male patients with an average age of 62.2 years were retrospectively evaluated. The average defect size was 21.3 × 10.5 cm2 (range: 10 × 8–24 × 16 cm2). An eccentrically located elliptical flap was constructed using a handheld Doppler device after detecting the perforator as the pivot point. The medial branch of the superficial circumflex iliac artery was used for all cases. Flaps were designed to cover 70–80% of the defect area and the average rotation arc was 165°. Results The average flap dimension was 19.7 × 7.7 cm2. Two cases showed partial necrosis in the flap tip area. There were no instances of total flap loss or lymphorrhea, or complications such as scar contracture, urination problems, erectile dysfunction, or discomfort during intercourse. Conclusions The SCIP flap is an effective and ideal method for penoscrotal reconstruction considering the loose, elastic, and thin nature of the tissue. Elevation is easily facilitated, and the thickness of the SCIP flap can be adjusted without microsurgery.

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

“…Despite the use of SCIP flap for locoregional groin reconstructions is already well‐known, its employment in the genital region is still limited. For this specific setting, only few case reports (Han et al, 2016; Koshima et al, 2006; Yoo et al, 2012) and two small case series (Han et al, 2019; Yamamoto et al, 2022) are available in literature so far. Moreover, there are no descriptions at all of the use of the SCIP flap for esthetic genital purposes.…”

“…Similarly, in 2012Yoo et al (2012) resorted to the SCIP flap, combined with ALT flap, for the reconstruction of the penis in a patient with traumatic genital amputation. In 2016, another case report byHan et al (2016) showed a successful scrotal reconstruction with SCIP flap after severe Fournier's gangrene.The first case series of penoscrotal reconstruction resorting to the SCIP flap was provided again byHan et al (2019) in 2019. Their work included 11 patients that received a propeller SCIP flap to cover genital male defects.…”

Penoscrotal defect reconstruction using loco‐regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm

“…Regarding the reconstruction of perineal defects, numerous studies have been published, with introducing diverse kinds of flaps including regional musculocutaneous flaps or perforator flaps, (Arquette et al, 2022; Ayestaray & Proske, 2015; Boissière et al, 2019; Han et al, 2018; Han et al, 2019; Kosutic et al, 2016; Ordenana et al, 2021; Ratanshi et al, 2017; Unverdi & Kemaloglu, 2019) and with suggesting several algorithms for selecting appropriate options based on defect size or anatomical subunits (Ahn et al, 2014; Chen et al, 2011; Guo et al, 2019; Hong et al, 2017; Xu et al, 2021; Zelken et al, 2016). Despite their elaborate works, most of them included only a small number of cases, which might not be sufficient to validate reliability and versatility of suggested reconstruction strategies, given a considerable diversity of perineal defects in terms of dimension, depth, and involved anatomical subunits.…”

“…Regarding the reconstruction of perineal defects, numerous studies have been published, with introducing diverse kinds of flaps including regional musculocutaneous flaps or perforator flaps, (Arquette et al, 2022;Ayestaray & Proske, 2015;Boissière et al, 2019;Han et al, 2018;Han et al, 2019;Kosutic et al, 2016;Ordenana et al, 2021;Ratanshi et al, 2017;Unverdi & Kemaloglu, 2019) and with suggesting several algorithms for selecting appropriate options based on defect size or anatomical subunits (Ahn et al, 2014;Chen et al, 2011;Guo et al, 2019;Hong et al, 2017;Xu et al, 2021;Zelken et al, 2016).…”

A Possible Distal End for Perforasome of the Superficial Circumflex Iliac Artery Perforator Flap

“…Herein, we propose a hypothesis regarding the location of the distal boarder of an SCIP perforasome by comparing 2 clinical cases with and without vascular supercharging.Case 1 was a 26-year-old man with scrotal lymphorrhea due to congenital lymphangioma, treated with resurfacing of the scrotum with a pedicled SCIP flap. 3 To cover the scrotal defect with one unilateral flap, the SCIP flap was designed beyond the costal arch. It was elevated from above the deep fascia, including both the deep and superficial branches of the SCIA, and introduced to the scrotum subcutaneously with its distal tip located in the caudal part of the defect.…”