Utility of Groin Flap in Penile Reconstruction

Abstract

Background: Reconstruction surgery for skin and soft tissue defects of the penis would ideally secure sufficient volume, be safe in procedure, and involve a simple surgical technique. Among the wide variety of techniques that have been employed, the groin flap-based technique is considered a relatively simple option for volumetric reconstruction. In this retrospective study, the authors report cases of penile reconstructive surgery using a groin flap.Methods: We performed a retrospective chart review of patients with penile defects treated in our department. Reconstructive surgeries were carried out using pedicled groin flaps. Charts were reviewed to investigate duration of the surgeries, recovery and follow-up periods, and bulkiness at one and 10 months after surgery. Patients were observed postoperatively for complications, urination, and erectile function.Results: Six patients hospitalized from March 2009 to September 2013 for penile defects underwent surgery in our department. All patients recovered without any flap loss. The most common complication after surgery was wound dehiscence. Circumferences of penile shafts were measured at 1 and 10 months after surgery, and penile bulkiness at rest were found to be maintained at >86%. There were no patients with contracture, and in all patients, urination and erectile functions were satisfactory.Conclusion: Reconstructing penile defects using groin flaps was found to be favorable in terms of volumetric reconstruction and postoperative patient satisfaction. Furthermore, the surgery and recovery periods are short, and rates of complication and donor site morbidity are also low.

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“…After exposing the vascular pedicle, dissection is carried to the femoral sheath to identify the origin of the superficial circumflex iliac artery from the femoral artery where the flap is then rotated and transposed to the site of inset. 25 Studies demonstrate an average range of 7.5−15 cm in length and 4−5 cm in diameter. Patient reported outcomes in terms of function and satisfaction are too scattered to provide any reliable benefit, and the complications represent a similar sequela to use in other forms of reconstruction with distal necrosis and venous congestion or edema being the most prevalent.…”

“…The flap is vascularly supplied by the superficial circumflex iliac artery and innervated primarily at the lateral margin of the flap opposite the pedicle by T12 contributions. 25 In the supine position, the inguinal ligament is palpated and marked before the superficial circumflex iliac artery is identified with the Doppler. In the event the artery is not audible, the anticipated vascular axes can be marked with parallel lines approximately 2.5 cm inferior to the inguinal ligament.…”

“…The primary disadvantage to using this flap refers to the limited innervation thereby rendering sensation of the phallus nearly absent. The flap is vascularly supplied by the superficial circumflex iliac artery and innervated primarily at the lateral margin of the flap opposite the pedicle by T12 contributions 25 …”

“…In the flap elevation, dissection is performed superficial to the deep fascia but extends deep to the fascia at the sartorius muscle to preserve the superficial circumflex iliac artery. After exposing the vascular pedicle, dissection is carried to the femoral sheath to identify the origin of the superficial circumflex iliac artery from the femoral artery where the flap is then rotated and transposed to the site of inset 25 …”