Techniques in Tissue Transfer: Plastic Surgery for the Urologist

Summary

The art and science of tissue transfer has evolved over centuries. Management options for reconstructing tissue defects, in degree of complexity, range from secondary intention to primary repair, to graft reconstruction, to flap reconstruction. Graft success id dependent on a well-vascularized host bed, rapid onset of imbibition, good apposition and immobilization, and rapid onset of inosculation. Flaps are primarily categorized by both their blood supply and their method of transfer. Random flaps do not have a defined or named blood supply. Axial flaps rely on a specific and defined vessel. Axial flaps are further divided by the course of the vascular pedicle that supplies the overlying tissue — namely musculocutaneous, fascio-cutaneous or neurocutaneous. Penile skin island flaps are fas-cio-cutaneous flaps, based on a pedicle of Dartos and anterior lamina of Bucks fascia. Flaps are also defined by the method of transfer — advancement, rotation, interpolation. Penile skin flaps are island and axial flap type. Flaps can be further categorized as local or distant flaps based on their proximity to the recipient site. Other flap techniques utilized for urologic reconstruction include: sliding advancement flap, rotation/transposition flap, tubed flap, pedicled muscle flap, and free flaps.