Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula condition
Background: 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 '' Turn over flaps urethroplasty'' and the ''Pedicular fasciocutaneous flap'' fro...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
|
| Series: | JPRAS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235258782300044X |
| _version_ | 1797405406737203200 |
|---|---|
| author | Alessandro Borgognone Giancarlo Delli Santi Giulio Baffigo Serena Vincenza Capobianco Stefania Goletti |
| author_facet | Alessandro Borgognone Giancarlo Delli Santi Giulio Baffigo Serena Vincenza Capobianco Stefania Goletti |
| author_sort | Alessandro Borgognone |
| collection | DOAJ |
| description | Background: 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 '' Turn over flaps urethroplasty'' and the ''Pedicular fasciocutaneous flap'' from the inferior gluteal fold. Unlike the traditional Perforator flap, we harvested a Pedicular flap; 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. Method: The urethroplasty technique adopted, the ‘Double turn over flaps urethroplasty’, 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 ''Pedicular fasciocutaneous flap'', have been considered to prevent any damage to the urethroplasty and at the same time to replace all the debrided scarred perineal tissue. Results: The follow-up confirmed a well-consolidated supple perineal area and a competent neourethra. Conclusions: The ''Pedicular flap'' 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 ''Turn over flaps urethroplasty'', 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. |
| first_indexed | 2024-03-09T03:10:17Z |
| format | Article |
| id | doaj.art-cb390b518c114f158db013bc10db9389 |
| institution | Directory Open Access Journal |
| issn | 2352-5878 |
| language | English |
| last_indexed | 2024-03-09T03:10:17Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JPRAS Open |
| spelling | doaj.art-cb390b518c114f158db013bc10db93892023-12-04T05:23:06ZengElsevierJPRAS Open2352-58782023-12-01389197Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula conditionAlessandro Borgognone0Giancarlo Delli Santi1Giulio Baffigo2Serena Vincenza Capobianco3Stefania Goletti4Operative Unit of Plastic Surgery and Burns, S. Eugenio – C.T.O. Hospital, Rome, Italy; Corresponding author at: ASL Roma 2, S. Eugenio -C.T.O. Hospital, Via S. Nemesio 21, Rome, 00145 Italy.Operative Unit of Plastic Surgery and Burns, S. Eugenio – C.T.O. Hospital, Rome, ItalyOperative Unit of Neuro- Urology, S. Eugenio – C.T.O. Hospital, Rome, ItalySpinal Cord Unit, S. Eugenio – C.T.O. Hospital, Rome, ItalyOperative Unit of Radiology, S. Eugenio – C.T.O. Hospital, Rome, ItalyBackground: 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 '' Turn over flaps urethroplasty'' and the ''Pedicular fasciocutaneous flap'' from the inferior gluteal fold. Unlike the traditional Perforator flap, we harvested a Pedicular flap; 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. Method: The urethroplasty technique adopted, the ‘Double turn over flaps urethroplasty’, 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 ''Pedicular fasciocutaneous flap'', have been considered to prevent any damage to the urethroplasty and at the same time to replace all the debrided scarred perineal tissue. Results: The follow-up confirmed a well-consolidated supple perineal area and a competent neourethra. Conclusions: The ''Pedicular flap'' 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 ''Turn over flaps urethroplasty'', 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.http://www.sciencedirect.com/science/article/pii/S235258782300044XLocal skin flaps for bulbar urethroplastyDouble turnover flaps urethroplastyPerineal reconstruction in patient with spinal cord injuryGluteal inferior fasciocutaneous flapUrethral–cutaneous fistulaPerineum reconstruction |
| spellingShingle | Alessandro Borgognone Giancarlo Delli Santi Giulio Baffigo Serena Vincenza Capobianco Stefania Goletti Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula condition JPRAS Open Local skin flaps for bulbar urethroplasty Double turnover flaps urethroplasty Perineal reconstruction in patient with spinal cord injury Gluteal inferior fasciocutaneous flap Urethral–cutaneous fistula Perineum reconstruction |
| title | Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula condition |
| title_full | Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula condition |
| title_fullStr | Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula condition |
| title_full_unstemmed | Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula condition |
| title_short | Is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral–perineal reconstruction? Considerations about a relapsing urethral–cutaneous fistula condition |
| title_sort | is a pedicular flap coupled to the double turnover flaps urethroplasty suitable for urethral perineal reconstruction considerations about a relapsing urethral cutaneous fistula condition |
| topic | Local skin flaps for bulbar urethroplasty Double turnover flaps urethroplasty Perineal reconstruction in patient with spinal cord injury Gluteal inferior fasciocutaneous flap Urethral–cutaneous fistula Perineum reconstruction |
| url | http://www.sciencedirect.com/science/article/pii/S235258782300044X |
| work_keys_str_mv | AT alessandroborgognone isapedicularflapcoupledtothedoubleturnoverflapsurethroplastysuitableforurethralperinealreconstructionconsiderationsaboutarelapsingurethralcutaneousfistulacondition AT giancarlodellisanti isapedicularflapcoupledtothedoubleturnoverflapsurethroplastysuitableforurethralperinealreconstructionconsiderationsaboutarelapsingurethralcutaneousfistulacondition AT giuliobaffigo isapedicularflapcoupledtothedoubleturnoverflapsurethroplastysuitableforurethralperinealreconstructionconsiderationsaboutarelapsingurethralcutaneousfistulacondition AT serenavincenzacapobianco isapedicularflapcoupledtothedoubleturnoverflapsurethroplastysuitableforurethralperinealreconstructionconsiderationsaboutarelapsingurethralcutaneousfistulacondition AT stefaniagoletti isapedicularflapcoupledtothedoubleturnoverflapsurethroplastysuitableforurethralperinealreconstructionconsiderationsaboutarelapsingurethralcutaneousfistulacondition |