Evaluation of Lateral Triangular Flaps When Combined With Bilateral Superficial Epigastric Artery Flap for Shaft-only Penile Reconstruction.

Abstract

Background: Phalloplasty represents a challenging complex genital reconstruction surgery. Phalloplasty should result in an aesthetic composite phallus, with the ability to void while standing, allowing placement of an implantable prostheses and preserving both tactile and erogenous sensation with minimal donor site morbidity.

Methods: A bilateral superficial epigastric artery flap was design in the supra pubic area, extending upward till the lower boarder of the umbilicus. Two triangular flaps were designed at the base of the main rectangular flap to facilitate further mobilization of the neophallus. A penile prosthesis was implanted at the same stage in some patients. Finally, the lateral abdominal flaps were dissected and mobilized to be closed primarily in the mid line.

Results: Twenty patients who were candidate for first stage of penile reconstruction were included in our study. The average flap dimensions were 18 × 15 cm; the largest was 32 × 18 cm, whereas the smallest flap was 15 × 113 cm. Eleven patients had immediate implantation with 2 failures due to impaired sensation. Four patients had tissue expansion before flap harvesting. Three patients developed partial flap loss during the first 2 weeks postoperatively.

Conclusions: The modified bilateral superficial epigastric artery flap is a convenient flap for neophallus reconstruction. Flap design and harvesting is simple with a minimal learning curve. The flap has good color match with well-hidden donor site morbidity. Also, the bilateral triangular flaps permit adequate caudal repositioning of the neophallus, which gives a more natural position.