Penile Reconstruction Using a Radial Forearm Free Flap with Modified Biemer

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Journal of the Korean Society for Surgery of the Hand 2002;11(2):146-152.
Published online November 30, 2002.

Seong Deok Kim, M.D., Bom Joon Ha, M.D*., Goo Hyun Mun, M.D., Won Sok Hyon, M.D., Sa Ik Bang, M.D., Kap Sung Oh, M.D.

변형 Biemer 방법에 의한 요골부위 전박 유리피판을 이용한 음경재건

김성덕·하범준*·문구현·현원석·방사익·오갑성

Abstract

  As the defects of the penis caused by trauma, surgical amputation, or congenital abnormality give the patients both psychological trauma and functional impairment, reconstruction of the penis is mandatory. Radial forearm free flap is reliable one-stage procedure, which can reconstruct both the phallus and the urethra. Chang and Whang’s adaptation of the “tube-in-a-tube” concept and its incorporation into a free flap design represented a major advance in microsurgical phallic construction. Biemer described a modification of the radial forearm flap design in which the neourethra was centered over the radial artery, but the phallic shaft was separated into two paraurethral swatches.
  The authors have performed one-stage penile reconstruction in two patients since 1998, using a radial forearm free flap. Our present design incorporates the original Biemer triple skin island and includes a fourth distal island for neoglans. One case was the amputation of the penis from felonious assault and the other case was the iatrogenic penile amputation from repetitive urologic surgery for congenital hypospadia. All patients showed aesthetically acceptable results and good tactile sensory recovery. Severe complications such as necrosis, fistula, or urethral stricture were not occurred. Biemer’s method modified by the authors is reliable one-stage penile reconstruction providing good aesthetic and functional results.

Key Words: Penis, Penile reconstruction, Radial forearm free flap

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