The super thin external pudendal artery (STEPA) flap

Phoon, Alex F.; Shah, Amit; Cormack, George C.; Saint‐Cyr, Michel

doi:10.1016/j.bjps.2014.05.044

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…The rate of scrotal surgery complications was well‐described in the literature with reported rate of hematoma and infections in 5% and 3.6% of case (Swartz, Morgan, & Krieger, ). As in this case, no impairment of erectile function and no impact on testicular function is described at this point in the literature (Phoon et al, ; Zhao, Zhang, Yu, & Long, ). Although no psychological impact of moving scrotal skin in the mouth was recorded, it needs to be taken into account.…”

Section: Discussionsupporting

confidence: 58%

“…The pedicle vessels have a satisfactory diameter, 2.81 mm for the external pudendal artery at its base and 4.44 mm for the external pudendal vein, with a pedicle length up to 11 cm after dissection within the subcutaneous tissue. The skin is thin and supple, 1.1 mm thick, ideal for cervicofacial reconstructions (Phoon et al, ). The absence of functional complication and the aesthetic result concerning the donor site make it a flap with low morbidity in comparison to the radial forearm flap (Benateau et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The primary disadvantages of the STEPA flap are the hairiness of the cutaneous palette, which can hinder the patient during hair growth, as well as the risk of inguinal lymphedemas, estimated at 10% (Phoon et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The primary criticisms are the sacrifice of one of the two major vascular axes of the hand and the functional and aesthetic morbidity caused at the donor site (Orlik et al, ). With equivalent features in terms of fineness and flexibility for minimal scarring, the scrotal free flap named super thin external pudendal artery (STEPA) flap was recently described and used for the reconstruction of critical areas such as limbs or joint areas at the shoulder or knee (Phoon, Shah, Cormack, & Saint‐Cyr, ). The STEPA flap was used for the first time in free form for the reconstruction of a foot defect in 2017 (Kiranantawat et al, ).…”

Section: Introductionmentioning

confidence: 99%

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The super thin external pudendal artery (STEPA) free flap for oropharyngeal reconstruction – A case report

et al. 2019

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The radial forearm flap is one of the most used micro‐anastomotic flaps in cervicofacial reconstruction in a carcinological context. This flap is an ideal in terms of reliability and fineness; it has, however, some disadvantages in terms of the functional and aesthetic complications of its donor site. In alternative to a radial forearm free flap, we report the use of the free super thin external pudendal artery flap (STEPA flap) for an oropharyngeal reconstruction. The aim was to decrease the donor site morbidity. A 71‐years‐old man with a T2N0M0 oropharyngeal squamous cell carcinoma has undergone surgical treatment. A left STEPA free flap was performed to reconstruct a defect about 8 × 6 cm2. This flap was designed as a half‐scrotal free flap sized 9 × 7 cm2 and was inset after tunneling of the pedicle at the floor of the mouth. A surgical revision was needed on the 15th day postoperative for disunion. There was no skin flap failure. After 12 month of follow‐up, no complication was observed at the donor site and no erectile dysfunction was recorded. Its characteristics in terms of fineness, flexibility, ease of conformation, and pedicle length are similar to those of the radial forearm flap with less aesthetic and functional sequelae of the donor site. The STEPA flap may be a promising free flap in oropharyngeal or oral cavity reconstruction.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The super thin external pudendal artery (STEPA) free flap for oropharyngeal reconstruction – A case report

et al. 2019

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“…According to the literature, the diameter of the EPAs is about 2 mm, which makes them easy to use in microsurgery (La Falce et al, 2006;Phoon et al, 2014) The landmark chosen by La Falce et al was the inguinal ligament, which is an oblique landmark (La Falce et al, 2006). It seemed to us that the horizontal bi-tubercular pubic line was a better landmark as it made the measurements more reproducible.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients

2022

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The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3 cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.

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Penoscrotal defect reconstruction using loco‐regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm

Kim

Sung

et al. 2022

Microsurgery

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Background: Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified algorithm for selecting reconstruction strategies.Methods: Patients with penoscrotal EMPD who were treated with wide excision and subsequent reconstruction from 2009 to 2020 were reviewed. Their demographics, operation-related characteristics, and postoperative outcomes were evaluated.Results: In total, 46 patients with a mean age of 64.9 years (range, 44-85 years) were analyzed. An average size of defects was 129.6 cm 2 (range, 8-900 cm 2 ). The most frequently involving anatomical subunit was scrotum, followed by suprapubic area and penile shaft. Twenty-six patients had defects spanning multiple subunits. The most commonly used reconstruction methods for each anatomical subunit were internal pudendal artery perforator (IPAP) flaps and/or scrotal flaps for scrotal defects, superficial external pudendal artery perforator (SEPAP) flaps for suprapubic defects, and skin grafts for penile defects. In all but four cases, successful reconstruction was achieved with combination of those reconstruction options. No major complications developed except for one case of marginal flap necrosis. All patients were satisfied with their aesthetic and functional results.Conclusions: Diverse penoscrotal defects following excision of EMPD could be solidly reconstructed with combination of several loco-regional options. A simplified algorithm using in combination of IPAP flap, SEPAP flap, scrotal flap, and skin graft may enable efficient and reliable reconstruction of penoscrotal EMPD defects. | INTRODUCTIONExtramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial adenocarcinoma localized to areas of apocrine gland distribution outside the mammary glands. It occurs most frequently in the external genitalia of women and less frequently in the external genitalia of men, perianal area, and axillary area. Clinically, EMPD manifests as an erythematous, eczematoid, and well-demarcated lesion with symptoms of pruritis and pain (Lloyd & Flanagan, 2000;

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The super thin external pudendal artery (STEPA) flap

Cited by 11 publications

References 26 publications

The super thin external pudendal artery (STEPA) free flap for oropharyngeal reconstruction – A case report

The super thin external pudendal artery (STEPA) free flap for oropharyngeal reconstruction – A case report

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients

Penoscrotal defect reconstruction using loco‐regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm

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