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Inicio Actas Urológicas Españolas (English Edition) Total phallic reconstruction using radial forearm free flap after iatrogenic pen...
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Vol. 41. Issue 7.
Pages 471-476 (September 2017)
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Vol. 41. Issue 7.
Pages 471-476 (September 2017)
New Techniques and Technologies
Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation
Reconstrucción fálica total con colgajo libre antebraquial radial tras amputación peneana iatrogénica
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J.C. Anguloa,
Corresponding author
jangulo@futurnet.es

Corresponding author.
, I. Arancea, C. Gómez-Llorensb, C. Esquinasa, C. Gómez-Martínc, J.L. Fernández-Cañamaquec
a Departamento Clínico, Facultad de Ciencias Biomédicas, Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain
b Zephyr Surgical Implants, Ginebra, Switzerland
c Servicio de Cirugía Plástica, Hospital Universitario de Getafe, Madrid, Spain
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Abstract
Introduction

The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male.

Material and methods

A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customized inflatable prosthesis a year later.

Results

During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10h and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the esthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration.

Conclusions

Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customized prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.

Keywords:
Penile amputation
Phalloplasty
Radial forearm free flap
Penile prosthesis
Resumen
Introducción

La pérdida del pene de causa iatrogénica es una circunstancia muy infrecuente. Se presenta un caso desafiante de reconstrucción peneana total diferida en varón genético.

Material y métodos

Varón de 57 años con pérdida del falo por absceso peneano y necrosis secundaria a cirugía de incurvadura peneana. La reconstrucción se realizó en varios tiempos empleando colgajo libre de antebrazo radial (CLAR) y colocación de prótesis inflable personalizada un año después.

Resultados

En un primer tiempo quirúrgico se llevó a cabo drenaje de absceso peneano, desbridamiento de restos necróticos y colocación de talla hipogástrica. Siete semanas después se llevó a cabo faloplastia con CLAR y construcción de neouretra tubo-en-tubo, anastomosis microquirúrgica múltiple y recubrimiento del sitio donante con injerto de piel del muslo de espesor parcial. La duración de esta cirugía fue 10 horas y tuvo como complicación crecimiento de vello en la neouretra, que obligó a depilación mecánica endoscópica en repetidas ocasiones. El paciente recuperó sensibilidad peneana, y 18 meses tras la faloplastia se le implantó prótesis Zephyr (Ginebra, Suiza) inflable de un solo cuerpo, utilizando la propia albugínea del cuerpo cavernoso proximal. El paciente se encuentra satisfecho desde el punto de vista cosmético, miccional y sensitivo. Cuatro meses después se encuentra ganando confianza para abordar la penetración.

Conclusiones

A pesar del riesgo de complicaciones postoperatorias y de la necesidad de operaciones múltiples, la reconstrucción fálica con CLAR y colocación de implante protésico personalizado puede mejorar el impacto en la función urinaria y sexual secundario a la pérdida del pene.

Palabras clave:
Amputación peneana
Faloplastia
Colgajo libre de antebrazo radial
Prótesis peneana

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