Pudendal Artery Flap Research Articles

SEPA Based Flap for Covering Defect after Adult Exstrophy Epispadias Repair

INTRODUCTION
 Bladder exstrophy is a complex, rare disorder that affects the foetus in utero. Here the abdominal wall is not fully formed, leaving the pubic bones separated and the bladder exposed in the lower abdominal wall.
 METHODOLOGY
 Single-stage reconstructive and repair surgery was undertaken in adults diagnosed with bladder exstrophy epispadias complex. The superficial external pudendal artery flap was considered for covering the defect after extensive reviews and discussion.
 CONCLUSION
 An uneventful surgery with recovery and a two-year follow-up post-surgery did not account for any complications following the procedure. This shows that the superficial external pudendal artery flap can be considered a favourable option for urologists in the repair of bladder exstrophy epispadias complex when undertaken in a single sitting surgery, especially in adults.
 MeSH Terms
 Bladder Exstrophy, epispadias repair, superficial external pudendal artery, axial-pattern flap.

Common Modalities of Reconstruction for Scrotal Defects at a Tertiary Care Hospital in Eastern India: An Observational Study

Introduction: Scrotal reconstruction remains a challenging problem to the surgeons. The various techniques used for scrotal reconstruction includes residual tissue re-arrangement, skin grafts, pedicled and free tissue transfer. There is lack of unified approach to deal with the issue. Aim: To discuss the surgical techniques performed for scrotal reconstruction in a tertiary care centre along with its epidemiological factors. Materials and Methods: This observational descriptive study was conducted on 33 cases in a tertiary care centre located in Eastern India over a period of three years. Scrotal reconstruction was planned according to aetiology, defect size, associated co-morbidity and age of the patient. Evaluation to assess the efficacy of each procedure was done with patient’s satisfaction scoring. At the time of discharge, with simple four level Likert scale, patient’s satisfaction was assessed. Descriptive statistics was used and results were expressed in terms of frequency and percentage. Results: The mean age of the patients with scrotal defects was 48±15.98 years. Fournier’s gangrene (n=21) was the leading cause of scrotal defects followed by trauma (n=8). The most common scrotal defect size was 50-75% (n=12). The most common scrotal reconstruction performed was Pudendal artery flap (Singapore flap) (n=12). Donor site scar was limited and acceptable. Wound related complications detected clinically as partial tissue necrosis, was observed in two cases. Most patients were satisfied with the final outcome, assessed by Likert scale. Conclusion: Scrotal reconstruction should be performed taking in account its aetiology, associated comorbidity, age and the scrotal defect size. Aesthetically and psychologically, well planned flap is reliable and better in comparison to Split-Thickness Skin Graft (STSG) and most of the complications can be managed conservatively.

Reconstruction of soft tissue penile defects due to trauma using inguinal flaps

Background: We present a case of using the external pudendal artery (EPA) flap to cover the soft tissue defects of the penis following multiple trauma with penis shrinkage, corpus spongiosum and urethral injuries. Case report: A 54-year-old male patient was admitted to the hospital with multiple injuries: complex trauma with extensive scrotal and perineal skin loss, soft tissue defects of the penis with corpus spongiosum and urethral injuries, complex and open forearm fracture. The patient underwent emergency surgery to remove scrotal skin, Burry the testis in the subcutaneous pouches in the thigh, Foley sonde was placed over the bladder above the pubic bone and amputate the right hand.After that, the patient was operated on using foreskin flaps to cover corpus spongiosum defects and reconstruct the urethra. However, after about 10 days, the foreskin flap was infected and then necrotic resulting in the soft tissue defects of the penis exposing the urethral.Therefore we decided to perform surgery using the external pudendal artery (EPA) flap to solve that problem. We put sonde foley to shallow urethra and let urine pass out. The cosmetic and functional results of this foreskin-flap have been good. There was no infection, the length of the penis was maintained. The urinary stream has been normal with no urine leakage after surgery. Conclusion: The external pudendal artery flap is a good option for the treatment of patients with penile soft tissue defects. Due to its simplicity, short operation time, easy dissection, good aesthetic outcome. Therefore the external pudendal artery flap is an optimal choice for the treatment of cases of genital soft tissue defects (scrota and penis).

Elevation of Thin Pudendal Artery Flap Using Fat Thickness Data in Vulvovaginal Reconstruction

Majority of defects after excision of vulvovaginal skin cancers is shallow in depth. A thin flap is thus suitable for pudendal defects. To create a thin pudendal artery flap, the relationship between fat thickness and age or body mass index (BMI) was examined. A total of 12 flaps in 7 cases were enrolled. In the initial 3 cases, five flaps were elevated in the subfascial plane of the gluteus maximus muscle based on the conventional method. In the 4th case with thick adipose tissue, the flap was elevated in the plane just below Camper’s fascia (CF). We then adopted this modified flap elevation method in 7 flaps of the 4th to 7th cases. By using computed tomography, we evaluated the perineal fat thickness (PFT) and gluteal fat thickness (GFT) to determine the thickness of the flap. All flaps survived completely. In all flaps prepared with the modified method, debulking was not required. The mean PFT (34.4 ± 2.8 mm) of the patients less than 70 years of age was significantly higher than that of patients of 70 years or more (21.0 ± 3.5 mm). The mean GFT (18.4 ± 1.1 mm) of the patients with BMI ≥ 25 was significantly higher than that of patients with BMI < 25 (11.8 ± 1.2 mm). To create a thin pudendal artery flap, the method of elevating the flap in the plane just deep to CF should be adopted, especially in patients less than 70 years of age or with BMI ≥ 25.

Morphometrics of Arterial Supply for External Pudendal Artery Flap in Koreans

Morphometrics of Arterial Supply for External Pudendal Artery Flap in Koreans

Penile Reconstruction with De-Epithelized Superficial External Pudendal Artery Flap

Complete loss of skin, Buck's fascia and tunica albuginea of the corpus cavernosum occurred on both sides of the penile shaft after placement of a penile prosthesis for the treatment of Peyronie's disease. We describe this unusual complication and surgical reconstruction of the penis with a de-epithelized superficial external pudendal artery axial pattern flap (January 1988). A good result was obtained.

The combined use of the superficial external pudendal artery flap with a flap of the anterior rectus sheath for the simultaneous cover of dorsal and volar defects on the hand

It is not easy to provide skin cover simultaneously to both the dorsal and the volar surface of an injured hand. A case is reported in which the dorsum of the hand was covered by a superficial external pudendal artery (SEPA) axial pattern flap (Dias, 1984) and the volar surface by a flap fashioned from the anterior rectus sheath, which in turn was covered with a split-skin graft. A good result was obtained.