The uses of the SEPA flap in the repair of defects in the hands and fingers

Dias, A.D.; Thatte, Ravin L.; Patil, Uddhav A.; Dhami, Lakshyajeet D.; Prasad, Madhva

doi:10.1016/0007-1226(87)90037-3

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…The external pudendal system has rarely been described in the literature, which is why we chose to perform an anatomical study. The course of the artery was first described by Salmon et al, then specified by Dias et al and Patil et al with the description of a “SEPA FLAP”(Dias et al, 1987; Louis, 1979; Patil et al, 1987). At that stage, the distal description was very precise but the frequent proximal anatomical variations of the external pudendal system were not considered.…”

Section: Discussionmentioning

confidence: 99%

“…This study was conducted after we had observed phalloplasty complications in some cases resulting from the choice of recipient pedicle. FLAP" (Dias et al, 1987;Louis, 1979;Patil et al, 1987). At that stage, the distal description was very precise but the frequent proximal anatomical variations of the external pudendal system were not considered.…”

Section: Discussionmentioning

confidence: 99%

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Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients

2022

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The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3 cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients

2022

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“…However, IPAP flap and SEPAP flaps were chosen as workhorse flaps in the current study. These two flaps are not novel, and their utility for reconstruction of perineal defect has been much reported (Brousse et al, 2019;Dias, 1984;Dias et al, 1987;Han et al, 2018;Hashimoto et al, 2014;Phoon et al, 2014). They are common in that their source perforators are Potential strength of this algorithm could be found in its relative simplicity and versatility.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Sung

et al. 2022

Microsurgery

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Background: Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified algorithm for selecting reconstruction strategies.Methods: Patients with penoscrotal EMPD who were treated with wide excision and subsequent reconstruction from 2009 to 2020 were reviewed. Their demographics, operation-related characteristics, and postoperative outcomes were evaluated.Results: In total, 46 patients with a mean age of 64.9 years (range, 44-85 years) were analyzed. An average size of defects was 129.6 cm 2 (range, 8-900 cm 2 ). The most frequently involving anatomical subunit was scrotum, followed by suprapubic area and penile shaft. Twenty-six patients had defects spanning multiple subunits. The most commonly used reconstruction methods for each anatomical subunit were internal pudendal artery perforator (IPAP) flaps and/or scrotal flaps for scrotal defects, superficial external pudendal artery perforator (SEPAP) flaps for suprapubic defects, and skin grafts for penile defects. In all but four cases, successful reconstruction was achieved with combination of those reconstruction options. No major complications developed except for one case of marginal flap necrosis. All patients were satisfied with their aesthetic and functional results.Conclusions: Diverse penoscrotal defects following excision of EMPD could be solidly reconstructed with combination of several loco-regional options. A simplified algorithm using in combination of IPAP flap, SEPAP flap, scrotal flap, and skin graft may enable efficient and reliable reconstruction of penoscrotal EMPD defects. | INTRODUCTIONExtramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial adenocarcinoma localized to areas of apocrine gland distribution outside the mammary glands. It occurs most frequently in the external genitalia of women and less frequently in the external genitalia of men, perianal area, and axillary area. Clinically, EMPD manifests as an erythematous, eczematoid, and well-demarcated lesion with symptoms of pruritis and pain (Lloyd & Flanagan, 2000;

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“…The superficial external pudendal artery (SEPA) flap is very versatile and has been used in other defect repair surgeries. [7] This fasciocutaneous flap used in these singlestage reconstructive surgeries is very mobile and can be rotated almost 180 degrees on either side. There are three superficial branches of the femoral artery in the groin.…”

Section: A B D O M I N a L W A L L D E Fe C T Smentioning

confidence: 99%

“…All three vessels radiate out from the saphenous opening and give off branches which are mostly arranged radially, like the spokes of a wheel, centred on the saphenous opening. [8,9,10] As the SEPA had remained unexploited, the present study was undertaken to ascertain its potential use in the closure of adult exstrophy and epispadias repair on either side of the midline, extending from the symphysis pubis to the umbilicus, designing the defect. Accurate knowledge of the anatomy of the vessel concerned is a prerequisite for skin flap (Figure 2).…”

Section: A B D O M I N a L W A L L D E Fe C T Smentioning

confidence: 99%

SEPA Based Flap for Covering Defect after Adult Exstrophy Epispadias Repair

Bolbandi¹,

Raghuveer

Agarwal

2022

jemds

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INTRODUCTION Bladder exstrophy is a complex, rare disorder that affects the foetus in utero. Here the abdominal wall is not fully formed, leaving the pubic bones separated and the bladder exposed in the lower abdominal wall. METHODOLOGY Single-stage reconstructive and repair surgery was undertaken in adults diagnosed with bladder exstrophy epispadias complex. The superficial external pudendal artery flap was considered for covering the defect after extensive reviews and discussion. CONCLUSION An uneventful surgery with recovery and a two-year follow-up post-surgery did not account for any complications following the procedure. This shows that the superficial external pudendal artery flap can be considered a favourable option for urologists in the repair of bladder exstrophy epispadias complex when undertaken in a single sitting surgery, especially in adults. MeSH Terms Bladder Exstrophy, epispadias repair, superficial external pudendal artery, axial-pattern flap.

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The uses of the SEPA flap in the repair of defects in the hands and fingers

Cited by 8 publications

References 3 publications

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients

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

SEPA Based Flap for Covering Defect after Adult Exstrophy Epispadias Repair

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