Single-Stage Repair of Extensive External Genital Defects by Superficial Circumflex Iliac Artery Perforator-Based Island Groin Flap

Abstract

Objectives: Skin grafts and flaps have been widely used for the reconstruction of partial external genital defects of various etiologies. But there are limitations, especially in the choice of donor site areas and with regard to postoperative daily care, which are caused by underlying medical conditions and extremely young or old ages. We describe the use of a single-stage, partially de-epithelialized, superficial circumflex iliac artery (SCIA) perforator-based island groin flap to reconstruct in such cases with extensive external genital defects. Methods: From January 2003 to July 2006, six male patients received SCIA perforator-based island groin flaps for reconstruction. The mean age was 40.0 years (range 2-65 years). The average body mass index was 22.02 (range 15.7-26.7). The defects requiring reconstruction were those following surgery for Fournier's gangrene in four adults and those caused by hypospadias with penile skin loss in two children. The flap dimensions ranged from 3 13 to 7 25 cm. The reconstructive areas included the penile shaft, scrotum and perineum. Results: The average follow-up period was 18 months (range 17-59 months). The flaps survived well in all patients except two who underwent reconstruction after surgery for Fournier gangrene. These two patients had small areas of marginal necrosis which needed further debridement and delayed closure. In two pediatric patients, the flaps grew in pace with the penis in the follow-up periods of 2 and 3 years, respectively. Neither flap maceration nor infection was observed. The creases of the flap and its pliability also improved with time for those ambulatory patients. Conclusions: The main advantages derived from our experience include the following: (1) it is a single-stage operation which shortens convalescence; (2) the cosmetic appearances of both the donor and recepient sites are good, and the morbidity rate is minimal; (3) the wound in the inguinal area does not affect daily care; (4) the donor site will not affect the care of the colostomy wound and so the infection rate decreases; (5) the flap will grow in pace with the penis. Such a procedure perforator-based island groin flap, to reconstruct an extensive external genital defect has only sparsely been reported. If we can overcome the technical difficulties in harvesting, our flap design will be a good choice for perineal reconstruction.