Browse > Article
http://dx.doi.org/10.1055/s-0042-1748662

Total Urethra and Penile Shaft Reconstruction with Combined Pedicled Anterolateral Thigh Flap and Radial Forearm Free Flap after Total Penectomy  

di Summa, Pietro Giovanni (Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne, University of Lausanne)
Sapino, Gianluca (Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne, University of Lausanne)
Bauquis, Olivier (Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne, University of Lausanne)
Publication Information
Archives of Plastic Surgery / v.49, no.3, 2022 , pp. 448-452 More about this Journal
Abstract
Total reconstruction of the penis (TPR) represents a challenge for urologists and plastic surgeons, especially when urethral length is severely reduced. We here describe, for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free flap (RFFF) for complete neourethra and glans reconstruction following penile amputation. A 48-year-old patient came to our department following a total penectomy with inferior urethral derivation. The indication for a double flap phalloplasty was posed as only way to fully reconstruct the urethra on its length avoiding possible complications of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully with no neourethral strictures or fistulas described. At 18 months follow-up, the patient was extremely satisfied with the aesthetic result and was able to void in standing position. We think that a double free tissue transfer for TPR should be considered, particularly when a urethral length > 14 cm needs to be reconstructed. While the pedicled ALT can be used to reconstruct a proper penile shaft with an easily concealed scar, the RFFF can provide adequate neourethra length with satisfactory sensory recovery at the neoglans.
Keywords
penile reconstruction; urethra reconstruction; ALT perforator flap; double flap;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 2006;59(02):153-157   DOI
2 Hakenberg OW, Drager DL, Erbersdobler A, Naumann CM, Junemann KP, Protzel C. The diagnosis and treatment of penile cancer. Dtsch Arztebl Int 2018;115(39):646-652
3 Marchioni M, Berardinelli F, De Nunzio C, et al. New insight in penile cancer. Minerva Urol Nefrol 2018;70(06):559-569
4 Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg 1984;74(02):251-258   DOI
5 D'Arpa S, Claes K, Lumen N, Oieni S, Hoebeke P, Monstrey S. Urethral reconstruction in anterolateral thigh flap phalloplasty: a 93-case experience. Plast Reconstr Surg 2019;143(02):382e-392e   DOI
6 Veerman H, de Rooij FPW, Al-Tamimi M, et al. Functional outcomes and urological complications after genital gender affirming surgery with urethral lengthening in transgender men. J Urol 2020;204(01):104-109   DOI
7 Watfa W, di Summa PG, Meuli J, Raffoul W, Bauquis O. MatriDerm decreases donor site morbidity after radial forearm free flap harvest in transgender surgery. J Sex Med 2017;14(10):1277-1284   DOI
8 Hong JP, Choi DH, Suh H, et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014;30(07):491-496   DOI
9 D'Arpa S, Colebunders B, Stillaert F, Monstrey S. Pre-expanded anterolateral thigh perforator flap for phalloplasty. Clin Plast Surg 2017;44(01):129-141   DOI
10 Lumen N, Monstrey S, Ceulemans P, van Laecke E, Hoebeke P. Reconstructive surgery for severe penile inadequacy: phalloplasty with a free radial forearm flap or a pedicled anterolateral thigh flap. Adv Urol 2008. Doi: 10.1155/2008/704343   DOI
11 Morrison SD, Son J, Song J, et al. Modification of the tube-in-tube pedicled anterolateral thigh flap for total phalloplasty: the mushroom flap. Ann Plast Surg 2014;72(Suppl 1):S22-S26   DOI
12 van der Sluis WB, Smit JM, Pigot GLS, Buncamper ME, Winters HAH, Mullender MG, Bouman MB. Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction. Microsurgery 2017;37(8):917-923   DOI
13 Garaffa G, Raheem AA, Christopher NA, Ralph DJ. Total phallic reconstruction after penile amputation for carcinoma. BJU Int 2009;104(06):852-856   DOI