Circumferential penile defect reconstruction with pull-up double-opposing keystone-designed perforator island flaps: A case report

Rationale:The challenges with reconstruction of penile defects are plenty. In addition, no single and universally accepted reconstructive method exists for penile defect repair. Herein, we present the application of a circumferential penile shaft defect reconstruction using pull-up double-opposing keystone-designed perforator island flaps (KDPIFs) in one patient. This is the first case report of a circumferential penile shaft defect reconstruction using KDPIFs.Patient concerns:A 43-year-old man who injected petroleum jelly into his penis 10years ago presented with multiple firm nodular mass-like lesions adherent to the overlying skin along the penile shaft. Our urologic surgeon removed the foreign bodies and performed a primary closure with undermining. However, wound dehiscence developed, and skin necrosis was exacerbated 5days postoperatively.Diagnoses:We performed debridement, and the final post-debridement defect was circumferential (5.5×12cm) from the base of the glans to the midpoint of the penile shaft.Interventions:We covered the defect using pull-up double-opposing KDPIFs (10×13cm each) based on the hot spots of the superficial external pudendal artery perforators on each side from the suprapubic area to the scrotum.Outcomes:The flaps survived perfectly, with no postoperative complications. The patient was satisfied with the final outcome and had no erectile dysfunction or shortening of penile length after a 6-month follow-up.Lessons:We successfully reconstructed a circumferential penile defect with pull-up double-opposing KDPIFs both esthetically and functionally. Our technique can be a good alternative modality for extensive penile defect reconstruction.