PD31-09 USE OF THE DEEP INFERIOR EPIGASTRIC VESSELS FOR ARTERIOVENOUS ANASTOMOSIS IN FREE-FLAP PHALLO-URETHROPLASTY: TECHNIQUE, KEY POINTS, AND LESSONS LEARNED

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-09 USE OF THE DEEP INFERIOR EPIGASTRIC VESSELS FOR ARTERIOVENOUS ANASTOMOSIS IN FREE-FLAP PHALLO-URETHROPLASTY: TECHNIQUE, KEY POINTS, AND LESSONS LEARNED Nance Yuan, Edward Ray, and Maurice Garcia Nance YuanNance Yuan More articles by this author , Edward RayEdward Ray More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most descriptions of free-flap phalloplasty use the femoral artery and great saphenous vein as recipient vessels. This generally requires end-to-side arterial anastomosis and sometimes interposed vein grafts. Use of the deep inferior epigastric vessels (DIEA/V) as recipient vessels has been rarely reported. We present our technique and experience with using the DIEA/V as recipient vessels for free-flap phalloplasty. METHODS: We retrospectively reviewed consecutive patients who underwent free-flap phalloplasty and/or urethroplasty at a single institution from September 2017 to September 2020. In all cases, the DIEA/V were used as recipient vessels. The DIEA/V pedicle was dissected through skin and fascial incisions in the lower abdomen and externalized through a passageway dissected at the medial aspect of the external inguinal ring. Demographics, surgical details, and outcomes were recorded. RESULTS: 31 flaps were anastomosed to the DIEA/V. Mean age was 38 years; mean BMI was 26.9. Mean follow-up was 22.8 months. 29 patients underwent phalloplasty (22 radial-forearm free flap, 9 anterolateral-thigh free flap). 2 patients underwent radial-artery flap urethroplasty. No femoral vessels or interposition grafts were used. Most (90.3%) flaps had two veins anastomosed, using the DIEV. Microvascular outcomes were excellent. Of 31 cases, there was only one case of operative takeback for venous congestion and one case (3.2%) of total flap loss. We explore the lessons learned from this case. There were six (19.4%) cases of dehiscence, most of which were minor and easily repaired. CONCLUSIONS: Use of the DIEA/V as recipient vessels for free-flap phalloplasty has shown excellent outcomes and is our preferred technique. Advantages associated with use of the DIEA/V include a short, direct course to the recipient vessels, good donor-recipient vessel size-match allowing end-to-end anastomosis instead of end-to-side anastomosis, elimination of risks associated with arterialized interposed veins (including potential aneurysm or blow-out from high-pressure flow), reliable dissection anatomy, and a well-hidden scar. Potential pitfalls to avoid include any factors that could compress the pedicle. In cases where venous outflow may be at risk, we recommend a low threshold to use additional local veins for anastomosis, though we rarely need additional veins given the reliability of the DIEV. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e542-e542 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nance Yuan More articles by this author Edward Ray More articles by this author Maurice Garcia More articles by this author Expand All Advertisement Loading ...