Perigenital Defect Reconstruction Post Giant Condyloma Acuminata Resection: Experience With The Double Keystone Flap

Abstract

Abstract: Due to its high recurrence, genital condyloma acuminata should be widely excised to include the full dermal thickness. Currettage is not advisable, as the rate of recurrence is high. The bigger the lession, the bigger donor area needed to close the defect. The reconstructive options do not merely depend on the defect area, but also on selecting a tissue donor of similar color, thickness, sensation and durability. The ease of donor transfer is equally important. Not many case of giant genital condyloma acuminata wide excision and reconstruction has been reported. For coverage of larger soft tissue defect, skin graft is the most common option; however durability is of concern and the perigenital area is a challenging area to graft. Two cases of perigenital reconstruction after giant genital condyloma excision is reported in this paper, using random perforator based flaps, the double keystone flap. Patient and Method: Both cases of giant genital condyloma underwent wide excision by the urologist and referred to our division for reconstruction. Both patients are male, and the defects were reconstructed using the double keystone flap. One patient needed a split thickness skin graft to cover remaining defect on the penile shaft. Result: In both cases, the double keystone flap successfully covered for the defects on the perigenital with tissue quality similar to its original characteristics. No complication ensued. All flaps were vital, no dehisence nor local infection occurred. Summary: The double keystone flap is a reliable option for the reconstruction of large defects on the perigenital region.