Bladder exstrophy radial artery phalloplasty: exstrophy related issues and saphenous vein interposition graft
Chiriaco, G1; Blecher, GA1; Johnson, M1; Sangster, P1; Christopher, NA1; Ralph, DJ1
1: University College London Hospitals (UCLH), United Kingdom
Objectives: Bladder exstrophy is a congenital abnormality that occurs along a spectrum of the exstrophy-epispadias complex. Cases of penile reconstruction are often difficult in men with bladder exstrophy due to prior and potential future surgeries and abnormal anatomy. Interposition grafts may be used in cases where vessels cannot be anastomosed directly.
Materials and Methods: This video shows the surgical steps of complex penile reconstruction and discusses specific exstrophy related issues. A 37 year old man with micropenis secondary to bladder exstrophy previously underwent numerous reconstructive procedures including failed mitrofanoff channel. Full thickness buttock skin grafts are harvested. The radial artery forearm flap is dissected and cephalic vein, radial artery and cutaneous sensory nerves are isolated. The usual end-to-side radial artery to common femoral anastomosis is not possible, due to pelvic distraction and vessels being further away from the phallus. Multiple prior and potential surgeries (for example Mitrofanoff revision) could risk the inferior epigastric artery injury with potential abdominal skin or neophallus devascularisation. At the groin, the long saphenous vein has issues with tortuosity, valves and higher risk of thrombosis and bleeding. The ankle segment is better suited as it is straight, smaller and will appropriately limit inflow thus reducing bleeding. The radial artery is anastomosed to the saphenous vein graft, cephalic vein to the great saphenous vein and an end-to-side anastomosis is performed between interposition graft and common femoral artery. Previously harvested skin grafts are applied to the forearm.
Results: The post operative time has been uneventful and a saphenous vein interposition graft was successfully used.
Conclusion: Typically, a tension free anastomosis is created from the inferior epigastric artery to the radial artery phalloplasty. We demonstrate the use of a saphenous vein interposition graft between the radial artery and the common femoral artery for the creation of a tension free anastomosis.
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