Clinical applications of the pedicled anterolateral thigh flap in penile reconstruction

Penile reconstruction remains a major challenge in plastic surgery and, over the years, a myriad of techniques has been employed to achieve a functional phalloplasty. Unfortunately, the more commonly used forearm free flaps also have significant drawbacks. The pedicled anterolateral thigh flap (ALTF) has numerous attributes, which make it a comparable, if not a better option, for penile reconstruction.

Between January 2007 and December 2009, 14 patients with partial or complete penile loss underwent reconstruction with a pedicled ALTF. The demographic data of the patients, cause of the defects, technique of reconstruction and the details about different flap parameters are presented here.

All the 14 patients were males, and the age range was between 27 and 60 years. Nine flaps were used for total penile reconstruction and five for partial penile reconstruction. The size of the flap ranged from 5 × 4 cm to 15 × 15 cm and was based on two perforators in four cases, while a single perforator was used in the rest. The perforators were musculocutaneous in 11 and septocutaneous in three patients. Primary urethral anastomosis was performed in three cases of total phalloplasty and all cases of partial phalloplasty (n=8), while in the rest, urethral continuity was established in a second stage. All the flaps survived completely.

We have found the pedicled ALTF to be a very versatile flap with wide range of applicability for partial as well as total phalloplasty.