Deep inferior e pigastric a rtery based f lap in urethral r econstruction

1. No. 198 Deep inferior epigastricartery based flap in urethral reconstruction Shrawan K Singh, RavimohanMavuduru, GautamBiswas, Santosh Kumar, Arup K Mandal Department of Urology and Plastic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, INDIA Posters Proudly Supported by: Introduction Peforators of deep inferior epigastric artery (DIEP) supply an area of anterior abdominal skin. The flap based on these perforators has been used for penile reconstruction. Anterior abdominal skin flap based on DIEP can be utilized to reconstruct urethra for bridging a long urethral defect when the penile flap in not available or feasible. Results All patients voided well on clamping the suprapubic catheter. One of them developed stricture at distal anastomotic site. He was managed with the revision of the anastomosis. Another patient had a voiding difficulty intermittently. He was found to have multiple mucosal polyps at proximal mucocutaneousanastomotic site. He underwent ablation of the polyps with Holmium laser. Fig.1: Large urethral defect Aim To evaluate the outcome of DIEP based anterior abdominal wall flap in urethral reconstruction. • Methods • Patients with large urethral defect following failure of urethroplasty for pelvic fracture urethral distraction defect. • Area of anterior abdominal wall skin marked at level of umbilicus and perforators were marked with Doppler. • Incision was made deep up to external oblique. Flap was raised till the perforators of DIEP encountered. • Anterior rectus sheath and muscle harvested with lateral sets of perforator and ipsilateral main inferior epigastricartery. • Skin tubularized over a Foley’s catheter, brought down to perineal region. Proximal and distal anastomosis with urethra performed. • Cather removed after pericathurethrogram showed no extravasation of contrast, after 3 weeks. Fig.2: Skin on anterior abdominal wall marked Fig.3: Marking of lateral & medial sets of perforators of DIEP Conclusions Deep inferior epigastric artery perforator based anterior abdominal flap is a viable option for urethral reconstruction when penile flap is not feasible. The procedure is relatively simple and doesn’t require microvascular setup Fig.5: Scar of anterior abdominal wall (Post-operatively) Fig.4: Tubularized flap with rectus muscle, lateral perforators and inferior epigastric artery Fig.6: Pericatheter retrograde urethrogram showing tube with adequate lumen and no extravasation of contrast