Single-Stage Repair of Extensive External Genital Defects by Superficial Circumflex Iliac Artery Perforator-Based Island Groin Flap

目的：植皮及皮瓣已廣泛地被運用在重建不同原因所造成的部份外生殖器缺損。然而各有其限度，尤其當病人本身存在高血壓、中風、糖尿病、感染、腹部造口、臥床等因素或因病人配合度差（年齡太小或太大）而限制了供皮瓣區的選擇及影響術後的照顧。我們利用骼淺迴旋動脈穿支島狀腹股溝皮瓣，以一階段、皮島部份去上皮化、島狀帶莖的方式，來重建這類病患。方法：自2003年1月至2006年7月，我們收集了6位男性病人（2位兒童及4位成人）來重建廣泛外生殖器缺損，年齡由2歲至65歲，平均年齡爲40.0歲。身體質量指數由15.7至26.7，平均爲22.02。4例爲Fournier壞死症，2例爲尿道下裂併陰莖皮膚缺損。獲取的皮瓣面積大小由3×13到7×25平方公分，而需重建的缺損部位有陰莖皮膚、陰囊及會陰周圍區域。結果：術後追蹤時間由17到59個月。所有皮瓣手術大致成功，除有2例皮瓣因小部份邊緣壞死而接受清創、縫合外，其他癒合良好。分別經2及3年之追蹤，2位兒童的皮瓣部分均可隨陰莖長大而延展。所有皮瓣均無再感染或皮膚磨損現象。可行動之病患其重建之陰囊皮膚的紋路及彈性也隨時間而改善。結論：藉由臨床的經驗得知這種作法的優點有：(1)重建手術一階段完成更可縮短復原時間。(2)兼顧重建區及供皮瓣區的美觀，並降低罹病率。(3)腹股溝疤痕較不影響日常抽痰、咳嗽、復健等動作。(4)可以避開腹部存在之腸造口或胃造瘻傷口，減少感染機會。(5)此皮瓣可隨陰莖長大而延展。以此穿支島狀腹股溝皮瓣來重建廣泛外生殖器缺損，以前未被完整報告過。若能克服取皮瓣時之技術困難，這將是重建會陰最重要的選擇之一。

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並列摘要

Objectives: Skin grafts and flaps have been widely used for the reconstruction of partial external genital defects of various etiologies. But there are limitations, especially in the choice of donor site areas and with regard to postoperative daily care, which are caused by underlying medical conditions and extremely young or old ages. We describe the use of a single-stage, partially de-epithelialized, superficial circumflex iliac artery (SCIA) perforator-based island groin flap to reconstruct in such cases with extensive external genital defects. Methods: From January 2003 to July 2006, six male patients received SCIA perforator-based island groin flaps for reconstruction. The mean age was 40.0 years (range 2-65 years). The average body mass index was 22.02 (range 15.7-26.7). The defects requiring reconstruction were those following surgery for Fournier's gangrene in four adults and those caused by hypospadias with penile skin loss in two children. The flap dimensions ranged from 3 13 to 7 25 cm. The reconstructive areas included the penile shaft, scrotum and perineum. Results: The average follow-up period was 18 months (range 17-59 months). The flaps survived well in all patients except two who underwent reconstruction after surgery for Fournier gangrene. These two patients had small areas of marginal necrosis which needed further debridement and delayed closure. In two pediatric patients, the flaps grew in pace with the penis in the follow-up periods of 2 and 3 years, respectively. Neither flap maceration nor infection was observed. The creases of the flap and its pliability also improved with time for those ambulatory patients. Conclusions: The main advantages derived from our experience include the following: (1) it is a single-stage operation which shortens convalescence; (2) the cosmetic appearances of both the donor and recepient sites are good, and the morbidity rate is minimal; (3) the wound in the inguinal area does not affect daily care; (4) the donor site will not affect the care of the colostomy wound and so the infection rate decreases; (5) the flap will grow in pace with the penis. Such a procedure perforator-based island groin flap, to reconstruct an extensive external genital defect has only sparsely been reported. If we can overcome the technical difficulties in harvesting, our flap design will be a good choice for perineal reconstruction.

並列關鍵字

deepithelialized pedicle ； perforator based island flap ； groin flap ； perineal defect

國際替代計量

Single-Stage Repair of Extensive External Genital Defects by Superficial Circumflex Iliac Artery Perforator-Based Island Groin Flap

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