Arch Hand Microsurg.  2018 Dec;23(4):296-300. 10.12790/ahm.2018.23.4.296.

Reconstruction of a Circumferential Penile Shaft Defect Using Bilateral Superficial External Pudendal Artery Perforator Flaps

• Park J
• Shin D
• Choi H
• Kim J
• Lee M

• KMID: 2427398
• DOI: http://doi.org/10.12790/ahm.2018.23.4.296

Abstract

Penile shaft reconstruction requires adequate soft tissue characteristics as well as constant vascular pedicles when considering a perforator flap. The free flap technique using various donor sites and regional conventional and perforator flaps have been utilized for penile shaft reconstruction. Still, the free flap techniques include challenging surgical procedures in addition to postoperative management. The regional flap can be applied to limited defects due to the size and shape. We performed the bilateral superficial external pudendal artery (SEPA) perforator flaps in order to reconstruct a circumferential penile shaft defect. The circumferential wound has noted necrotic tissue involving superficial (Dartos) fascia. We underwent debridement, preserving deep (Buck's) fascia and corpus spongiosum. Thereafter, the soft tissue defect was covered with bilateral SEPA perforator flaps. The patient has been observed for 27 months, showing penile resilience without deformity or wound-related problems.

Keyword

Penis; Circumference; Reconstruction; Perforator flap

MeSH Terms

Arteries*
Congenital Abnormalities
Debridement
Fascia
Free Tissue Flaps
Humans
Male
Penis
Perforator Flap*
Tissue Donors
Wounds and Injuries

Figure

• 

  Fig. 1 A 49-year-old man was referred from the urology department, where he had received repeated debridement and repair to resolve penile abscess. The circumferential wound was noted at 3×10 cm of necrotic tissue involving superficial (Dartos) fascia.

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  Fig. 2 We underwent debridement, preserving deep (Buck's) fascia and corpus spongiosum. Thereafter, soft tissue defects have been covered with bilateral superficial external pudendal artery perforator flaps.

• 

  Fig. 3 Illustration of the right superficial external pudendal artery (SEPA) perforator flap when it was elevated. A: femoral artery and vein, B: external pudendal artery and vein, C: long saphenous vein, D: SEPA perforator, E: anterior scrotal branch of external pudendal artery and vein.

• 

  Fig. 4 Circumferential penile shaft defect has been reconstructed using bilateral superficial external pudendal artery perforator flaps successfully. A thin subcutaneous layer of the flap is advantageous in preserving resilience.

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