Deep external pudendal artery perforator (DEPAP) flap with scrotal septal flap phalloplasty: a single-stage sensate phal
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ORIGINAL PAPER
Deep external pudendal artery perforator (DEPAP) flap with scrotal septal flap phalloplasty: a single-stage sensate phallus Magdy Abd Al Moktader 1 Received: 29 June 2020 / Accepted: 17 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The loss of a penis has a devastating effect on one’s life with significant psychogenic implications. The main goals of the surgery are to create cosmetically acceptable sensate phallus with a neo-urethra to allow voiding and enough bulk for the insertion of a penile prosthesis. We aim to evaluate the functional and esthetic results of a new single-stage sensate phallus using a deep external pudendal artery as a perforator/propeller (DEPAP) flap, with scrotal septal flap for the urethral reconstruction. Methods A total of 12 male patients (mean age: 35 years), 10 with normal BMI and 2 overweight, presented with penile amputation underwent penile reconstruction with the unilateral DEPAP flap. The urethra was reconstructed, employing a scrotal septal flap, using the tube in the tube technique. Donor sites in both flaps were closed primarily. Penile prosthesis insertion was performed 6 months post-operatively. Sexual function evaluation was carried out using the International Index of Erectile Function (IIEF). Results Average operative time was 180 min. Flap survival and urethral reconstruction were uneventful, except for one case of distal tip necrosis of the flap which healed by secondary intention. Patients obtained sensate penis with good length and contour, allowing penile prothesis implantation and voiding in upright position. IIEF revealed satisfactory erection and penetrative intercourse, indicating favorable sexual functioning. Conclusions The DEPAP flap, wreathen scrotal septal flap, has proven to be a highly reliable technique for single-stage phalloplasty, with excellent esthetic appearance, same skin color, providing a good contour and sensate pleasure. Donor site morbidity was negligible. Level of evidence: Level IV, therapeutic study. Keywords Propeller flaps . Perforator flaps . Genitourinary reconstruction . Penile reconstruction . Phalloplasty
Introduction Penile loss is a devastating condition with significant psychological and physical negative impacts on different aspects of life, including social relationships, as well as a relationship with a partner. Phallic reconstruction involves building a penis that could be rendered functional for both urinary and sexual purposes. The procedure
* Magdy Abd Al Moktader [email protected]; [email protected] 1
Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
is particularly essential to men who have encountered severe trauma or loss of a penis through illness. The construction procedure is a challenging surgery aimed to find a solution to the problem of the amputated penis. It might involve either utilizing an existing tissue or making use of new tissue [1, 2]. Penile reconstructive operations have limited
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