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Reconstruction of Acquired Defects of the External Genitalia: A 24 Patient, Single Institution Experience
Joseph S. Weisberger MD, MS1, John B. Park PahrmD2, Dane Pizzo MS2, Emily A. Van Kouwenberg MD2, Richard L. Agag MD2, Jeremy C. Sinkin MD2
1Rutgers New Jersey Medical School, Newark NJ; 2 Rutgers Robert Wood Johnson Medical School, New Brunswick NJ

Purpose: Patients undergoing resection of the external genitalia are often faced with deformity and decreased quality of life. Plastic surgeons are tasked with the challenge of reconstructing these defects to minimize morbidity and increase patientsí quality of life. The authors have set out to investigate the efficacy of local fasciocutaneous and pedicled perforator flaps in external genital reconstruction.
Methods: A retrospective review was conducted of all patients undergoing reconstruction of acquired defects of the external genitalia from 2017-2021. In total 24 patients met inclusion criteria for the study. Patient were allocated into two cohorts; Patients with defects reconstructed using local fasciocutaneous flaps (FC) versus patients with defects reconstructed using pedicled islandized perforator flaps (PF). Comorbid conditions, ablative procedures, operative times, flap size, and complications were compared across all groups. Fischerís exact test was used to analyze differences in comorbidities, while independent t-tests was used to analyze age, BMI, operative time and flap size. Significance was set at p<0.05.
Results: Of the 24 patients included in the study, 6 underwent reconstruction with islandized perforator flaps (either profunda artery perforator, or anterolateral thigh), and 18 underwent reconstruction with fasciocutaneous flaps. The most common indication for reconstruction was vulvectomy for vulvar cancer, followed by radical debridement for infection, and lastly penectomy for penile cancer. The PF cohort had a significantly higher percentage of previously irradiated patients (50% vs 11.1%, p=0.019). Although mean flap size was larger in the PF cohort this difference did not reach statistical significance (176 cm2 vs 143.4 cm2, p=0.5). PF had significantly longer operative times when compared to fasciocutaneous flaps (237.33 min vs 128.99 min, p=0.003). Average length of stay was 6.88 days in FC and 5.33 days in PF (p=.624). Complication profile including flap necrosis, wound healing delays, and infection were similar between groups despite a significantly higher rate of prior radiation in the PF cohort.
Conclusion: Our data suggests that perforator flaps such as profunda artery perforator and anterolateral thigh flaps are associated with longer operative times but may offer a suitable option for reconstruction of acquired defects of the external genital compared to local fasciocutaneous flaps, especially in the setting of prior radiation.


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