Background: Penile reconstruction or phalloplasty has always been one of the most challenging problems for plastic surgeons. In 1936, Bogoras performed the first phalloplasty by using traditional tubed pedicle flaps. Many other flaps and methods have been applied since, including lower abdominal flaps, pudendal-thigh flaps, parascapular flaps, paraumbilical flaps and, of course, radial forearm flaps. For each method, reports of both functional and esthetic successes abound.
In this case, donor sites for phalloplasty were somewhat limited by the severe electric burn injury. After much consideration, we decided to preexpand the scapular flap and to use this for phalloplasty, with satisfactory outcome.
Our case is a 31-year-old patient who sustained a 19% total burn surface area by electrical burn in August 2011. The burn area involved both forearms, abdominal region, both femoral regions, and perineum including genitalia loss. Most of the burn wounds were skin grafted shortly after the injury. Due to the nature of the burn, regular donor sites for penile reconstruction were unavailable. Before surgery, we went through a detailed plan for phalloplasty with the patient and his family. The patient consented to the 2-stage surgery for the penile reconstruction.
The first stage was insertion of a 600-mL soft tissue expander in the scapular region. After 4 months of expansion, the second stage of free scapular flap transfer was performed in March 2012.
Results: The reconstruction was successful with good appearance and patient satisfaction, complicated by urethral fistula. Eight months later, the urinary fistula was repaired successfully.
Conclusions: The free scapular flap proved to be an ideal solution to this patient’s dilemma. The flap has adequate amount of tissue and a reliable blood supply. Its amenability to be expanded allows better donor-site primary closure. Tissue bulk resulted in adequate stiffness without artificial prosthesis for the phallus to be functional.
From the Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi People’s Republic of China.
Received April 28, 2014, and accepted for publication, after revision, May 5, 2014.
Conflicts of interest and sources of funding: none declared.
The authors contributed equally for this manuscript.
Reprints: Wei Xia, MD, Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, 15 West Changle Road, Xi’an, Shaanxi 710032. E-mail: firstname.lastname@example.org; and Wensen Xia, MD, Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, 15 West Changle Road, Xi’an, Shaanxi 710032. E-mail: email@example.com.
Liwei Dong and Yulin Dong contribute equally for this manuscript.