Deep External Peudendal Artery (DEPA) Perforator Flap for Phalloplasty a Single Stage Sensate Phallus

Abstract

Background:

Loss of the penis can have a devastating effect on the lives of sufferers with significant psychogenic implications. Penile reconstruction or phallus construction poses a difficult challenge and a demanding problem to the plastic surgeons. Different techniques have been used for construction of a total penis and reconstruction of severely injured penis. The main goals of surgery are the creation of a cosmetically acceptable sensate phallus with the incorporation of a neourethra to allow voiding and with enough bulk to allow the insertion of a penile prosthesis for sexual intercourse (1)

Deep external peudendal artery (DEPA) flap has been described for scrotal reconstruction (2), but not described before for phalloplasty.

Aim:  

 To evaluate the functional and aesthetic results of one-stage penile reconstruction (phalloplasty) using a deep external peudendal artery (DEPA) flap as a new technique, single stage sensate phallus.

Methods:

Twelve flaps in 12 patients with penile amputation due to human insult and infection post penile process were subjected to reconstruction using unilateral DEPA flap for total phalloplasty. Urethra was reconstructed by scrotal septal flap.  The neourthera was wrapped by the DEPA flap as one stage. Donor site was closed primarily in both flaps.

Results: All 12 DEPA and scrotal flaps survived completely, one DEPA flap only with distal 2 cm necrosis healed by dressing, additionally, the donor site was closed directly, and the scar was hidden in the perineal crease. The donor site healed uneventfully, as one patient healed by secondary intention   .

Conclusion: deep external peudendal artery (DEPA) flap is highly reliable sensate flap for phalloplasty, with excellent aesthetic appearance of the penis, as it's thin, non-hairy, of the same colour, giving a good contour and near normal sensation of the penile skin. Also the donor site morbidity is negligible in normal hidden crease

References 

• Babaei,A. Safarinejad, M.  Farrokhi,F. and Iran-Pour,F. Penile Reconstruction: Evaluation of the Most Accepted Techniques . Urology Journal  2010  Vol 7 No 2; 71-78
• Abd Almoktader MA. Anteriorly based pudendal thigh flap for scrotal reconstruction based on the deep external pudendal artery (DEPA) flap    Eur J Plast Surg 2016;39:107–112