Use Of Gracilis Muscle Flap Research Articles

(520) The Use of Gracilis Muscle Flap in Radial Forearm Free Flap Phalloplasty to Decrease Urethral Fistula Rate: Initial Outcome

Abstract Introduction `- Chang and Hwang, in 1984, described the technique of Radial Forearm Free Flap Phalloplasty (RFFFP). It is now considered to be the standard surgery for phallic reconstruction. Urethral fistula is the most common complication reported in RFFFP and may reach up to 60-70%. Most commonly, the fistula site is at the anastomosis between the native urethra and the neo-urethra. Objective `- to study the impact of gracilis muscle flap wrapping around the native urethra/neo-urethral anastomosis on decreasing the fistula rate. Methods `- A prospective study was conducted at our urology department, from January 2018 till December 2020. - Patients presenting with a micropenis (Stretched penile length <7 cm) underwent RFFFP with gracilis muscle flap wrapping. - The free-flap was harvested from the non-dominant forearm. Under microscopic guidance, the radial artery was anastomosed with the inferior epigastric artery, the cephalic vein with the great saphenous vein, and the medial and lateral antecubital nerves with the ilio-inguinal and the dorsal penile nerves respectively. - A pedicled gracilis muscle flap was then wrapped around the neo-urethera/native urethral anastomosis to assess its possible role in decreasing the postoperative urinary fistula rate. Results `- Nineteen patients were included in the study with a median age of 26 years (16 - 43) and a BMI of 24 (22-25). The median hospital stay of 14 days (14 - 21) and the median follow-up was 11 months (4 - 13). The median cold ischemia time was 90 mins (70 - 100), estimated blood loss was 500 cc (400 - 500) and operative time was 11 hrs (10 - 12). - A viable phallus was achieved in 13 patients (overall free flap survival 68.4%). - Of the successfully viable phallus cases, 8 cases (42.1%) were complicated by complete disruption of the urethra and the remaining five cases (26.3%) had complete urethral tube. - One case of them developed a fistula at the neo-urethera/native urethral anastomosis, one case had a distal fistula and one case had a ring stricture at the site of anastomosis. - The gracilis muscle flap prevented urethral fistula formation in 4 out of 5 cases (80%) with complete urethral tube. Conclusions `- The use of pedicled garcilis muscle flap wrapping around the neo-urethra/native urethral anastomosis during RFFP might be helpful in reducing the urinary fistulae rates at this site. However, larger comparative studies are needed. Disclosure No

Scrotal reconstruction with pedicled gracilis muscle flap following Fournier\u2019s gangrene: a case report and literature review

BackgroundFournier’s gangrene is an acute soft tissue necrotizing infection involving the perineum and the external genitalia which can result in a major loss of the scrotal wall with exposure of the testicles. Reconstruction of such major defect is quite challenging; the use of pedicled gracilis muscle flap helps to create an aesthetically acceptable scrotum with minimal donor site morbidity.Case presentationWe described the case of a 60-year-old man with a large scrotal loss from Fournier’s gangrene following bladder outlet obstruction and perineal abscess. He had multiple debridement and reconstruction with pedicled left gracilis muscle flap with a good aesthetic and functional post-operative outcome. The major challenge encountered was the loss of the skin graft as a result of the retraction of the muscle flap due to too early ambulation; this can thus be avoided by adequate pre-operative counseling and enforcing bed rest.ConclusionsThe use of gracilis muscle flap in the reconstruction of large scrotal defect described in this report has the additional advantage of creating a pliable and soft feel like that of the original scrotum with minimal donor site morbidity.

Urologic use of gracilis muscle flap for nonhealing perineal wounds and fistulas

A chronic sinus or urinary fistula in the perineum secondary to surgery and/or radiation therapy for pelvic malignancy may cause serious morbidity and be difficult to treat. The gracilis muscle, either by itself or as a myocutaneous flap, has excellent properties for aiding in healing. Over a six-year period, three nonhealing perineal wounds and three urinary fistulas have healed after the gracilis muscle flap procedure.