Keystone Flaps in Urethroplasty: Reconstruction in a Complex Case of Panurethral Stricture Disease

Panurethral strictures are a surgical challenge for a reconstructive urologist more so in situations where local tissue for reconstruction is deficient. Two-stage urethroplasty is the preferred option in such cases. In some complex stricture diseases where patients are not willing for multiple procedures, permanent perineal urethrostomy can give a good functional outcome. Keystone flaps have been used as a simple and effective method of wound closure in other areas of the body that would otherwise have required complex flap closure and skin grafting. We describe, for the first time, a case of inflammatory panurethral stricture disease complicated by Fournier gangrene with extensive penile, scrotal, and perineal skin deficit managed with a perineal urethrostomy, with the help of keystone design perforator island flaps with successful outcome.