di Summa Pietro Giovanni, Sapino Gianluca, Bauquis Olivier
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland.
Arch Plast Surg. 2022 May 27;49(3):448-452. doi: 10.1055/s-0042-1748662. eCollection 2022 May.
Total reconstruction of the penis (TPR) represents a challenge for urologists and plastic surgeons, especially when urethral length is severely reduced. We here describe, for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free flap (RFFF) for complete neourethra and glans reconstruction following penile amputation. A 48-year-old patient came to our department following a total penectomy with inferior urethral derivation. The indication for a double flap phalloplasty was posed as only way to fully reconstruct the urethra on its length avoiding possible complications of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully with no neourethral strictures or fistulas described. At 18 months follow-up, the patient was extremely satisfied with the aesthetic result and was able to void in standing position. We think that a double free tissue transfer for TPR should be considered, particularly when a urethral length > 14 cm needs to be reconstructed. While the pedicled ALT can be used to reconstruct a proper penile shaft with an easily concealed scar, the RFFF can provide adequate neourethra length with satisfactory sensory recovery at the neoglans.
阴茎全重建（TPR）对泌尿外科医生和整形外科医生来说是一项挑战，尤其是当尿道长度严重缩短时。我们在此首次描述了在肿瘤学情况下，一种双皮瓣阴茎成形术，使用带蒂股前外侧（ALT）皮瓣进行阴茎重建，以及桡骨前臂游离皮瓣（RFFF）进行阴茎切除术后完整新尿道和龟头重建。一名48岁患者在接受全阴茎切除及低位尿道改道后前来我院就诊。双皮瓣阴茎成形术被认为是完全重建尿道长度、避免使用管中管技术进行单皮瓣重建可能出现并发症的唯一方法。两个皮瓣均顺利愈合，未出现新尿道狭窄或瘘管。在18个月的随访中，患者对美学效果非常满意，并且能够站立排尿。我们认为，对于TPR应考虑采用双游离组织移植，特别是当需要重建尿道长度＞14 cm时。虽然带蒂ALT皮瓣可用于重建合适的阴茎体，且瘢痕易于隐藏，但RFFF可提供足够的新尿道长度，且新龟头的感觉恢复令人满意。
