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Tytuł:
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Pedicled Anterolateral Thigh and Radial Forearm Free Flap Phalloplasty for Penile Reconstruction in Patients With Bladder Exstrophy.
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Autorzy:
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Harris TGW; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Manyevitch R; Jeffs Division of Pediatric Urology, Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Wu WJ; Jeffs Division of Pediatric Urology, Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Leto Barone AA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Bivalacqua TJ; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Burnett AL; The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Gearhart JP; Jeffs Division of Pediatric Urology, Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Redett RJ 3rd; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Źródło:
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The Journal of urology [J Urol] 2021 Mar; Vol. 205 (3), pp. 880-887. Date of Electronic Publication: 2020 Oct 07.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2019- : [Philadelphia, PA] : Wolters Kluwer
Original Publication: Baltimore : Lippincott Williams & Wilkins
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MeSH Terms:
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Free Tissue Flaps*
Bladder Exstrophy/*surgery
Epispadias/*surgery
Penis/*abnormalities
Penis/*surgery
Plastic Surgery Procedures/*methods
Adolescent ; Adult ; Forearm/surgery ; Humans ; Male ; Penile Prosthesis ; Retrospective Studies ; Thigh/surgery
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Contributed Indexing:
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Keywords: bladder exstrophy; epispadias; penis; surgical flaps
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Entry Date(s):
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Date Created: 20201007 Date Completed: 20210414 Latest Revision: 20221207
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Update Code:
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20240105
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DOI:
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10.1097/JU.0000000000001404
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PMID:
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33026935
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Purpose: Male patients with exstrophy-epispadias complex have a congenitally short penis. Adolescent and adult patients often desire penile reconstruction to enable penetrative intercourse. When penile lengthening using local tissue and/or skin graft is unsuitable, phalloplasty is performed. We provide updated experiences using radial forearm free flap and pedicled anterolateral thigh flap phalloplasty techniques over a 6-year period in exstrophy-epispadias complex patients.
Materials and Methods: Consecutive patients who underwent radial forearm free flap or pedicled anterolateral thigh flap phalloplasty between 2013 and 2019 were reviewed. A total of 11 patients were identified, including 8 with classic bladder exstrophy and 3 with cloacal exstrophy. In each case, flap dimensions, donor and recipient vessels and nerves, complications, outcomes and subsequent surgical procedures are reported.
Results: A radial forearm free flap was performed in 6 patients and a pedicled anterolateral thigh flap in 5. Flap survival was observed in all cases and 5 patients subsequently received an inflatable penile prosthesis. Among patients undergoing a pedicled anterolateral thigh flap, there was 1 mortality from acute pulmonary embolism, and the other 4 required at least 1 debulking procedure.
Conclusions: Phalloplasty is an important procedure in patients with exstrophy-epispadias complex with severe penile inadequacy. Both techniques have favorable long-term outcomes, although the pedicled anterolateral thigh flap frequently requires a later debulking procedure. The radial forearm free flap is preferred but if the radial forearm is overly thin and the risk of inflatable penile prosthesis extrusion is high, the pedicled anterolateral thigh flap is an acceptable alternative.
Comment in: J Urol. 2021 Mar;205(3):886. (PMID: 33393833)
Comment in: J Urol. 2021 Mar;205(3):887. (PMID: 33393834)
