The blood supply to preputial island flaps

Area of Science:

• Anatomy
• Surgical Anatomy
• Vascular Anatomy

Background:

• The prepuce develops through folding and epithelial growth, separating from the glans post-vascularization.
• Its blood supply originates from external pudendal arteries, with venous return via transverse veins connecting to dorsal subcutaneous veins.
• The dual surfaces of the prepuce share a single blood supply, necessitating their treatment as a unified structure.

Purpose of the Study:

• To elucidate the vascular anatomy of the prepuce.
• To understand the implications of prepuce vascularization for surgical techniques.
• To identify potential complications related to flap viability in reconstructive surgery.

Main Methods:

• Detailed anatomical dissection of the prepuce and its vascular supply.
• Histological examination of prepuce tissues.
• Surgical simulation to assess flap viability and blood supply dynamics.

Main Results:

• The prepuce possesses a terminal arterial supply from external pudendal arteries and a venous drainage system along the dorsal shaft.
• The outer and inner preputial surfaces share a common, unified blood supply.
• Surgical manipulation, such as unfolding or raising flaps, can compromise the prepuce's vascular integrity, leading to ischemia.

Conclusions:

• The prepuce's vascular supply dictates its surgical handling, requiring preservation of the pedicle containing superficial blood vessels.
• Ischemia in proximal prepuce portions can occur when used as ventral cover due to exclusive flap circulation.
• A double-faced flap technique is proposed to mitigate complications associated with compromised blood supply in reconstructive procedures.