CAJ | 학술논문

目的介绍股前外侧皮瓣带蒂转移再造阴茎的手术方法,探讨其临床应用效果及可行性.方法 2011年5月至2014年5月,对12例阴茎缺损的患者,应用股前外侧皮瓣带蒂转移进行阴茎再造术,皮瓣面积为11 cm×11 cm～12 cm×15 cm.8例患者以"管中管"的形式在皮瓣中央设计皮瓣再造尿道,4例应用阴囊中隔瓣再造尿道.一期进行尿道吻接者4例,于阴茎再造6个月后进行二期尿道吻接者8例.结果 12例皮瓣完全成活10例,皮瓣血运不良致再造阴茎全部坏死1例,术后皮瓣部分坏死继发感染1例,上述2例均采用对侧股前外侧皮瓣带蒂转移完成阴茎再造.术后获随访10例,时间为1～4年,平均1.5年,9例患者对再造阴茎外形满意,其中4例已婚者自述能够完成性生活;8例患者排尿功能正常,2例患者发生再造尿道皮肤瘘,于术后6～12个月行局部皮瓣转移尿瘘修补术.结论应用旋股外侧动脉降支为蒂的股前外侧皮瓣带蒂转移进行阴茎再造,方法相对简单,无需吻合血管,血运可靠,形态满意,供区隐蔽.
목적 개소고전외측피판대체전이재조음경적수술방법,탐토기림상응용효과급가행성.방법 2011년5월지2014년5월,대12례음경결손적환자,응용고전외측피판대체전이진행음경재조술,피판면적위11 cm×11 cm～12 cm×15 cm.8례환자이"관중관"적형식재피판중앙설계피판재조뇨도,4례응용음낭중격판재조뇨도.일기진행뇨도문접자4례,우음경재조6개월후진행이기뇨도문접자8례.결과 12례피판완전성활10례,피판혈운불량치재조음경전부배사1례,술후피판부분배사계발감염1례,상술2례균채용대측고전외측피판대체전이완성음경재조.술후획수방10례,시간위1～4년,평균1.5년,9례환자대재조음경외형만의,기중4례이혼자자술능구완성성생활;8례환자배뇨공능정상,2례환자발생재조뇨도피부루,우술후6～12개월행국부피판전이뇨루수보술.결론 응용선고외측동맥강지위체적고전외측피판대체전이진행음경재조,방법상대간단,무수문합혈관,혈운가고,형태만의,공구은폐.
Objective To introduce the application of pedicled anterolateral thigh (ALT) flap for total penile reconstruction and to investigate its feasibility and effect.Methods From May 2011 to May 2015,12 male patients presented with absence of the penis or congenital malformation received phalloplasty with the pedicled ALT flap.Of them, the median age was 35 years old (range, 20-57 years).The size of the flaps ranged from 11 cm× 11 cm to 12 cm × 15 cm.8 patients underwent urethra reconstruction with tube-in-tube flaps and other 4 patients with scrotal septal flaps.In this series, we performed one-stage urethral anastomosis in 4 cases and second-stage urethral anastomosis 6 months after the phalloplasty in 8 cases.Results An acceptable reconstructed phallus was achieved in 10 patients.These flaps were primarily healed with satisfactory functional and cosmetic results.The reconstructed penis was completely necrosis because of the flap failure in one case.The distal half of the phallus was lost due to infection in one case.Both of them were treated with pedicled ALT flap from the other side.Reliable results were achieved.At a median follow-up of 1.5 year (range 1 to 4 years) , 9 patients (90％) were fully satisfied with phallic cosmesis and size, and 4 patients who was married had successful sexual intercourse.8 patients had normal urinate function.Fistula was developed in 2 patients (20％) which was treated with delayed repair at 6-12 months with local scrotal flaps.Conclusions The pedicled ALT flap can be simply used to reconstruct an entire penis as well as a urethra.It has several advantages including a less conspicuous donor site, greater bulk, better color match and no necessary for microsurgery.