Repair of complex penile defect with composite anterolateral thigh and vascularized fascia lata flap

Yazar, Sevgi Kurt; Eroğlu, Muzaffer; Gökkaya, Ali; Semerciöz, Atilla

doi:10.5505/tjtes.2015.47629

Cited by 6 publications

(8 citation statements)

References 20 publications

(58 reference statements)

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“…When grafts and local flaps are inadequate or unavailable, other options should be considered including microsurgical flap transfers, the appendix, and intestinal segments. 1 It also depends on patient's characteristics and preferences. 3 Penile reconstruction has good outcomes in terms of quality of life and sexual function.…”

Section: Discussionmentioning

confidence: 99%

“…It also provided continuity with the surrounding cutaneous tissue, leading to better venous and lymphatic drainage and a better cosmetic appearance. 1 22 The fascia lata was transferred and combined to the ALT flap as a vascularized graft, receiving its blood supply via the prefascial and subfascial vascular plexus. 1 Since it has a pliable and stretchable structure with no hair, it was also described to create a tube-shaped neourethra 1 avoiding postoperative complications such as infection, stone formation, fistula, and strictures.…”

Section: Discussionmentioning

confidence: 99%

“…Some defects are not possible to reconstruct with skin or mucosa grafts, and even local flaps may be precluded for previous surgery, trauma, or complex wounds. 1 Good quality of life and functional outcomes have been reported with distant flaps such as the radial forearm free flap, but it has an unfavorable donor-site scar location and is contraindicated in the absence of collateral circulation of the hand. A good and emerging alternative is the anterolateral thigh (ALT) pedicled flap.…”

mentioning

confidence: 99%

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Salvage of a Near-Total Penile Amputation following Urinary Fistulization and Carbapenemase-Producing Klebsiella pneumoniae Infection with a Composite ALT Flap and Vascularized Fascia Lata

et al. 2021

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Reconstruction of complex penile defects is always challenging, as some defects are not possible to reconstruct with skin or mucosa grafts, and even local flaps may be precluded in complex wounds. We present a case of a 63-year-old otherwise healthy man, who underwent transurethral resection of the prostate for benign prostatic hyperplasia. After the procedure, he developed panurethral necrosis with consequent stricture. Three urethroplasties for reconstruction of the bulbar and distal urethra using buccal mucosa grafts, a preputial flap, and penile skin were performed by urology team in different institutions, but serious urinary fistulization and carbapenemase-producing Klebsiella pneumoniae (KPC) infection translated in a chronic wound, urethra necrosis, and near-total penile amputation. A composite anterolateral thigh flap and vascularized fascia lata were used with success together with a perineal urethroplasty in different stages, improving the ischemic wound condition. The extended segment of fascia lata was used for Buck's fascia replacement and circumferential reinforcement to cover the erectile bodies of the penis. The postoperative period was uneventful and after 12 months, there were no signs of recurrence or wound dehiscence. He was able and easily adapted to void in a seated position through the perineal urethrostomy that was made. To the best of our knowledge, this procedure has not been reported previously as a salvage procedure in a fistulizated and KPC infected penis, but it may be considered to avoid penile amputation in chronic infected and intractable wounds.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Salvage of a Near-Total Penile Amputation following Urinary Fistulization and Carbapenemase-Producing Klebsiella pneumoniae Infection with a Composite ALT Flap and Vascularized Fascia Lata

et al. 2021

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“…Reconstruction of the urethra and penile or scrotal skin defects with good functional and cosmetic results presents challenges for surgeons. The selection of proper techniques depends on the size of the defect, condition of the local tissue and status of the wound [9].…”

Section: Discussionmentioning

confidence: 99%

“…Flaps and grafts, and even the appendix and intestinal segments, have been used as alternative techniques [17–21], and most of these techniques were staged procedures. Yazar [9] and colleagues reported a one-stage technique to repair a complex penile defect with composite anterolateral thigh and vascularized fascia lata flaps. In that case, the vascularized fascia lata flap was utilized to repair the lateral and ventral semicircular wall defect of the urethra.…”

Section: Discussionmentioning

confidence: 99%

Staged male genital reconstruction with a local flap and free oral graft: a case report and literature review

Zheng¹,

Xie²,

Fu³

et al. 2019

BMC Urol

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BackgroundMale genital skin loss is a common disease in urology. However, male genital skin loss accompanying a penile urethra defect is rarely reported. Herein, we describe a novel surgical technique using a composite local flap and oral mucosal graft to reconstruct the penis, which may provide a new solution for patients with similar conditions.Case presentationA 36-year-old male with a penile urethra defect and a large area of genital skin loss required urethral reconstruction. The meatus had descended to the penoscrotal junction. This procedure was divided into three stages. The first stage of the surgery involved burying the nude penile shaft beneath the skin of the left anteromedial thigh for coverage of the skin defect. The second stage consisted of releasing the penis and expanding the size of the urethral plate for further urethroplasty. The third stage consisted of reconstruction of the anterior urethra 6 months later. Postoperatively, the patient reported satisfactory voiding. The maximal flow rate (MFR) was 22.2 ml/s with no postvoiding residual urine at the 24-month follow-up visit. No edema, infection, hemorrhage, or cicatricial retraction were observed. The patient’s erectile function was satisfactory, and his international index of erectile function-5 score (IIEF-5 score) was 23 at the 24-month follow-up visit. Additionally, the presence of nocturnal penile tumescence demonstrated that he had normal erectile function.ConclusionsThis procedure is an effective surgical option for men with complete foreskin and penile urethra defects. It could also be extended as a treatment strategy when composite local or pedicle transposition flaps and free grafts are needed for specific patients.

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Colgajo libre de piel para defecto de cubrimiento de piel peneana – reporte de caso

et al. 2018

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Introducción Reportar el caso de un paciente con lipogranuloma esclerosante de pene llevado a corrección de curvatura peneana compleja, con injerto de espesor parcial y posterior retracción secundaria, que generó curvatura peneana impidiendo el coito y que al momento de corrección quirúrgica, se generó un defecto de cubrimiento dérmico que requirió el uso de colgajo con piel de la pared abdominal. Materiales y Métodos Hombre de 46 años con antecedente de resección de lipogranuloma esclerosante en cara dorsal del pene resecado en el año 2006 y disfunción eréctil en manejo con terapia intracavernosa con prostaglandina E2; con necesidad de injertos de piel de abdomen en 2 oportunidades para cubrimiento de defecto de piel, con posterior fibrosis y curvatura peneana dorsal de aproximadamente 60° asociado a dolor con la erección. Llevado a corrección de curvatura peneana compleja en Hospital Universitario Mayor- Méderi. Se realiza plicatura de la túnica albugínea con técnica de Yachia hasta la verificación de corrección de curvatura dorsal en un 90%. Se identifica área con defecto de cubrimiento, por lo cual se levanta colgajo en región hipogástrica abdominal y se realiza anclaje del colgajo en borde distal del defecto de cubrimiento. Seis semanas después, es llevado a segundo tiempo quirúrgico, con liberación y remodelación del colgajo y se realiza el anclaje del colgajo en el borde proximal del defecto. Tres meses después, se revalúa el paciente encontrándose cubrimiento completo del área cruenta en región dorsal del pene. Se induce erección con alprostadil intracavernoso evidenciándose curvatura peneana dorsal de menos de 5°. Discusión Los pacientes con lipogranuloma esclerosante del pene generan placas en túnicas peneanas que al momento de ser resecadas, pueden requerir el uso de segmentos de piel para cubrimiento con injertos o colgajos pediculados en un terreno con alta probabilidad de daño por isquemia de dichos tejidos. En los casos en los que ocurre contracción del injerto se generan curvaturas peneanas que en caso de que impidan el coito requieren corrección de la misma. El uso de injertos autólogos o aloinjertos ha presentado resultados satisfactorios, sin embargo, puede requerir dos tiempos quirúrgicos para la obtención de tejido. En pacientes en quienes la piel peneana no es suficiente para cubrir el defecto, la segunda opción es la piel escrotal, que conserva características similares, así como una excelente vascularización. Cuando no se cuenta con piel escrotal en buen estado, se usa un injerto de piel de espesor total como última opción con resultados satisfactorios. Conclusiones Actualmente, el uso de piel de abdomen en esos defectos de piel no tiene amplia acogida dada la presencia de anexos dérmicos que terminan generando un aspecto estético no óptimo, sin embargo, se evidencia en este caso, que es un tejido que se adapta fácilmente a su nueva ubicación y permite el fin último, que es lograr una adecuada función del órgano receptor.

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Repair of complex penile defect with composite anterolateral thigh and vascularized fascia lata flap

Cited by 6 publications

References 20 publications

Salvage of a Near-Total Penile Amputation following Urinary Fistulization and Carbapenemase-Producing Klebsiella pneumoniae Infection with a Composite ALT Flap and Vascularized Fascia Lata

Salvage of a Near-Total Penile Amputation following Urinary Fistulization and Carbapenemase-Producing Klebsiella pneumoniae Infection with a Composite ALT Flap and Vascularized Fascia Lata

Staged male genital reconstruction with a local flap and free oral graft: a case report and literature review

Colgajo libre de piel para defecto de cubrimiento de piel peneana – reporte de caso

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