Use of Fasciocutaneous and Myocutaneous Flaps in Complex Urethral Reconstruction

The management of complex urethral pathology with associated adverse local tissue environment often requires the use fasciocutaneous, muscular and myocutaneous flaps. While these complex cases are a minority of those encountered by the reconstructive urologist, it is essential to have good working knowledge of how and when to utilize these reconstructive techniques. In this chapter we will detail a variety of flaps and composite flap/graft techniques that are utilized in complex reconstruction for a variety of case scenarios. The perineal artery fasciocutaneous flap is a versatile flap that can be utilized for perineal wound coverage and also for bulbar urethral reconstruction. The gracilis muscular flap is one of the major workhorses in urologic reconstruction given its proximity to the perineum and minimal donor site morbidity related to flap harvesting. The gracilis muscle can be used to support buccal mucosal grafts and also used to fill in perineal dead space in a variety of situations. Similarly, the gluteus maximus flap, while less commonly used, is an important tool at the disposal of the reconstructive urologist. The rectus abdominus muscular and myocutaneous flaps can also be used to fill in dead space in the pelvis and perineum in select situations.