Axial flaps for treatment of penis lesions due to granulomas

Granulomas can result from subcutaneous injection of ointment into the penis to augment its bulk. Rigid, infiltrated granulomatous and scar tissue prevents coitus, often ulcerates, and must be excised. Large segmental or circumferential defects of the penile integument must be covered with soft, pliable skin. We describe our experience with axial skin-fat flaps taken for this purpose from the groin region. There are two well-known vascular bundles, the arteria circumflexa ilium superficialis (ACIS) and arteria epigastrica superficialis (AES). Both were used successfully (the ACIS in 3 patients and the AES in 1) to provide island skin territories sufficient for resurfacing even a completely degloved penis (1 patient) with primary donor wound closure and rapid healing. In addition, a new flap, based on the arteria pudenda externa, was designed and implemented in 1 patient. The donor potential of the groin and lower abdominal region amply meets the requirements for penis reconstruction. Therefore, it is surprising that axial flaps have not yet become broadly accepted.