Is a coupled to the suitable for urethral-perineal reconstruction? Considerations about a relapsing urethral-cutaneous fistula condition.

This study highlights the effectiveness, in one surgical stage, of two combined local techniques for perineal fistula repair in a patient with spinal cord injury: the " and the " from the inferior gluteal fold. Unlike the traditional , we harvested a ; by definition, this is a flap with a narrow diffuse microvascular supply aimed in our case at shielding the neourethra and substituting the remaining scarred perineum. The urethroplasty technique adopted, the has been based on sculpting two opposing local cutaneous flaps circumscribing the fistulous cutaneous openings. Eventually, the neourethra continuity has been re-established by turning over both flaps and making them meet medially. The dimension and thickness of the " have been considered to prevent any damage to the urethroplasty and at the same time to replace all the debrided scarred perineal tissue. The follow-up confirmed a well-consolidated supple perineal area and a competent neourethra. The " is by definition a random vascular flap nourished through a narrow pedicle, not based on a single perforator but only on a diffuse, spread micro-perforators. When associated with the double ", it represents a possible alternative to achieve satisfactory results for those physical and psychological challenges encountered in the treatment of recurrent urethral fistula of the perineum in a patient with spinal cord injury.