Horta Ricardo, Mendes Margarida, Barreiro Diogo, Almeida Alexandre, Jarnalo Mariana, Teixeira Sérgio, Pinto Rui
Department of Plastic and Reconstructive Surgery and Burn Unity, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Urology, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal.
Surg J (N Y). 2021 Sep 14;7(3):e237-e240. doi: 10.1055/s-0041-1735649. eCollection 2021 Jul.
Reconstruction of complex penile defects is always challenging, as some defects are not possible to reconstruct with skin or mucosa grafts, and even local flaps may be precluded in complex wounds. We present a case of a 63-year-old otherwise healthy man, who underwent transurethral resection of the prostate for benign prostatic hyperplasia. After the procedure, he developed panurethral necrosis with consequent stricture. Three urethroplasties for reconstruction of the bulbar and distal urethra using buccal mucosa grafts, a preputial flap, and penile skin were performed by urology team in different institutions, but serious urinary fistulization and carbapenemase-producing (KPC) infection translated in a chronic wound, urethra necrosis, and near-total penile amputation. A composite anterolateral thigh flap and vascularized fascia lata were used with success together with a perineal urethroplasty in different stages, improving the ischemic wound condition. The extended segment of fascia lata was used for Buck's fascia replacement and circumferential reinforcement to cover the erectile bodies of the penis. The postoperative period was uneventful and after 12 months, there were no signs of recurrence or wound dehiscence. He was able and easily adapted to void in a seated position through the perineal urethrostomy that was made. To the best of our knowledge, this procedure has not been reported previously as a salvage procedure in a fistulizated and KPC infected penis, but it may be considered to avoid penile amputation in chronic infected and intractable wounds.
复杂阴茎缺损的重建一直具有挑战性，因为有些缺损无法用皮肤或黏膜移植进行重建，对于复杂伤口甚至可能无法采用局部皮瓣。我们报告一例63岁的健康男性病例，该患者因良性前列腺增生接受了经尿道前列腺切除术。术后，他出现了全尿道坏死并继发狭窄。泌尿外科团队在不同机构分别进行了三次尿道成形术，使用颊黏膜移植、包皮瓣和阴茎皮肤重建球部和远端尿道，但严重的尿瘘形成和产碳青霉烯酶（KPC）感染导致了慢性伤口、尿道坏死和近乎阴茎全切。在不同阶段成功联合使用了股前外侧复合皮瓣和带血管的阔筋膜，并进行了会阴尿道成形术，改善了缺血性伤口状况。将延长的阔筋膜用于替代Buck筋膜并进行环形加固，以覆盖阴茎的勃起体。术后恢复顺利，12个月后无复发或伤口裂开迹象。他能够且轻松地通过所做的会阴尿道造口术以坐姿排尿。据我们所知，此前尚未有将此手术作为瘘管形成且感染KPC的阴茎的挽救手术的报道，但对于慢性感染且难以处理的伤口，可考虑采用此手术以避免阴茎切除。
