Aesthetic Penoscrotal Resurfacing: Creating Propeller Flaps from Gluteal Folds

Background: Reconstruction of extensive penoscrotal defects is a surgical challenge. Resurfacing defects in highly complex three-dimensional structures and restoring their function are an essential part of the reconstruction of penoscrotal regions. Objective: We describe a technique using internal pudendal artery perforator ( IPAP) pedicled propeller flaps created from the gluteal fold. This could be a reliable surgical option that maintains a natural looking scrotal pouch with minimal donor site morbidity and optimal sexual activity. Design, setting, and participants: We retrospectively reviewed data for 10 consecutive patients who had undergone penoscrotal reconstruction using IPAP pedicled propeller flaps between January 2011 and March 2015. Surgical procedure: The IPAP was identified using a hand-held Doppler ultrasound device. This was the pivot around which the flap was internally rotated more than 908 in a tension-free manner. The long axis of the flap was centred on the gluteal fold to provide a better-orientated donor site scar. Measurements: Complications and patient satisfaction with respect to size, colour match, scar appearance, and sexual activity were evaluated. Results and limitations: Anatomic and aesthetic penoscrotal reconstruction was performed without any major complications in the follow-up period (mean, 19.7 mo). The mean width of the IPAP pedicled propeller flaps was 6.7 cm, and the mean length was 11.7 cm. Partial distal flap necrosis occurred in only one case, and healed spontaneously. All of the patients were satisfied with the cosmetic and functional results. Conclusions: On the basis of reliable perforators, donor site morbidity, flap thickness, and a better orientated scar, our technique using IPAP pedicled propeller flaps created from the gluteal fold could be a reasonable surgical option for extensive penoscrotal reconstruction. Patient summary: The creation of pedicled propeller flaps using an internal pudendal artery perforator could be a reliable surgical option for reconstruction of extensive penoscrotal defects. The approach yields functional and aesthetically acceptable surgical results. (c) 2016 Published by Elsevier B. V. on behalf of European Association of Urology.