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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(03): 448-452
DOI: 10.1055/s-0042-1748662
Extremity/Lymphedema
Case Report

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

Pietro Giovanni di Summa
1   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
,
Gianluca Sapino
1   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
,
Olivier Bauquis
1   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
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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

Author Contributions

P.d.S. designed the study. G.S. drafted the first version of the manuscript. O.B. and P.d.S. were the senior consultants involved in the surgery. All authors read and approve the final version of the manuscript.


Ethical Approval

The study was conducted accordingly to the guiding principles following the Declaration of Helsinki of 1975, informed consent was obtained from the patients.


Patient Consent

The patient signed an informed consent, allowing for publication of sensible data as well as photo/video material.




Publication History

Article published online:
27 May 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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