Staged total penile reconstruction using flap prefabrication and arteriovenous loop

Abstract

Loss of penis due to injury or disease is physically and psychologically devastating to any male. While the technique of penile reconstruction continues to evolve in conjunction with the evolution of flaps in reconstructive surgery, the free tissue transfer using radial artery forearm flap (RAFF) in a single stage is recognized as the most preferred method at present. However, to avoid the complications often seen in such single-stage method, we used a novel two-stage technique for total penile reconstruction in two cases after penile loss. We prefabricated the neophallus in the forearm and constructed saphenofemoral arteriovenous loop in the groin in the first stage to allow all the suture lines to heal and provide for easy and reliable recipient vessels. The neophallus was transferred after 4 weeks and vessel anastomoses done conveniently in the groin with adequate sized vessels with robust inflow. Both the patients recovered well without any need for urinary diversion and quickly attained the ability to pass urine in standing position. We offer that the two-stage method of penile reconstruction using free RAFF is reliable, easy to perform and can avoid many of the complications seen with single-stage reconstruction.