Sadove R C, Sengezer M, McRoberts J W, Wells M D
Department of Surgery, University of Kentucky Chandler Medical Center, Lexington.
Plast Reconstr Surg. 1993 Dec;92(7):1314-23; discussion 1324-5.
This is the first series of total penile reconstructions with the free sensate osteocutaneous fibula flap. The main advantages of this flap lie in its intrinsic rigidity, its superior donor-site location, and its long vascular pedicle. The fibula flap provides better bone volume than does the radial forearm flap, which commonly results in a floppy phallus in the absence of bone. Penile prostheses in other flaps have enjoyed limited success. Forearm donor-site complications can be avoided. The donor site in the lower extremity can be readily covered with a sock. The vascular pedicle of the fibula flap is of sufficient length to allow end-to-side anastomosis of the flap to the femoral artery. Interpositional vein grafts are unnecessary, and dissection of the inferior epigastric artery system to serve as a donor artery may be avoided. The appearance of the neophallus is excellent. We present only the first four continuous cases of the six we have performed because sufficient follow-up data are available only for these four. The advantages and disadvantages of fibula and forearm donor sites, the long-term fate of the bony component, the importance of sensation, and the vascularized urethral reconstruction are discussed. High patient satisfaction and the advantages of the technique convince us that the fibula osteocutaneous flap is superior for total penile reconstruction.
这是首例采用游离带感觉的腓骨骨皮瓣进行全阴茎再造的系列报道。该皮瓣的主要优点在于其固有的硬度、供区位置优越以及血管蒂较长。与桡骨前臂皮瓣相比，腓骨皮瓣能提供更多的骨量，而桡骨前臂皮瓣在无骨支撑时通常会导致阴茎松软。在其他皮瓣中应用阴茎假体的效果有限。前臂供区并发症可以避免。下肢的供区很容易用袜子覆盖。腓骨皮瓣的血管蒂长度足够，可将皮瓣与股动脉进行端侧吻合。无需进行静脉移植，也可避免解剖腹壁下动脉系统作为供体动脉。再造阴茎的外观极佳。我们仅展示了已完成的6例中的前4例连续病例，因为只有这4例有足够的随访数据。本文讨论了腓骨和前臂供区的优缺点、骨成分的长期转归、感觉的重要性以及带血管蒂的尿道重建。患者的高满意度以及该技术的优势使我们确信，腓骨骨皮瓣在全阴茎再造方面更具优势。
