Deep external pudendal artery perforator (DEPAP) flap with scrotal septal flap phalloplasty: a single-stage sensate phallus

Abstract

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. 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). 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. 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.