Abstract
Total reconstruction of the penis (TPR) represents a challenge for urologists and
plastic surgeons, especially when urethral length is severely reduced. We here describe,
for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled
anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free
flap (RFFF) for complete neourethra and glans reconstruction following penile amputation.
A 48-year-old patient came to our department following a total penectomy with inferior
urethral derivation. The indication for a double flap phalloplasty was posed as only
way to fully reconstruct the urethra on its length avoiding possible complications
of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully
with no neourethral strictures or fistulas described. At 18 months follow-up, the
patient was extremely satisfied with the aesthetic result and was able to void in
standing position. We think that a double free tissue transfer for TPR should be considered,
particularly when a urethral length > 14 cm needs to be reconstructed. While the pedicled
ALT can be used to reconstruct a proper penile shaft with an easily concealed scar,
the RFFF can provide adequate neourethra length with satisfactory sensory recovery
at the neoglans.
Keywords
penile reconstruction - urethra reconstruction - ALT perforator flap - double flap
