Reconstrucción peniana mediante microcirugía en Costa Rica / (Penile reconstruction with microsurgery)

ResumenEl pene tradicionalmente se ha considerado un símbolo de poder, masculinidad y fertilidad, por lo cual toda patología peniana congénita o adquirida, que eventualmente culmine en la amputación parcial o total del falo, constituye un evento catastrófico para cualquier hombre, presentando efectos devastadores, tanto físicos como psicológicos. Los diferentes niveles de amputación peniana en un individuo pueden definir su capacidad de miccionar y de concretar el coito, lo que perjudica directamente su virilidad y desempeño sexual y, por ende, su bienestar psicológico. Todo esto justifica el esfuerzo reconstructivo que se pueda ofrecer con el fin de mejorar la calidad de vida del paciente. El colgajo libre radial de antebrazo se ha considerado por muchos años el estándar de oro en reconstrucción peniana, ya que ha demostrado buenos resultados funcionales y estéticos. Esta técnica microquirúrgica representa un gran avance reconstructivo, lo cual se traduce en un rescate de la autoestima y de la masculinidad del paciente, con mejoría significativa de su calidad de vida. A continuación se presenta el caso clínico de un paciente masculino de 35 años de edad, quien requirió una amputación casi total de pene, secundaria a una quemadura eléctrica severa, y posteriormente fue sometido a la primera reconstrucción peniana microquirúrgica con colgajo libre radial de antebrazo, en Costa Rica.

AbstractThe penis has traditionally been considered a symbol of power, masculinity and fertility, so any congenital or acquired penile pathology that eventually culminates in partial or total amputation of the phallus constitutes a catastrophic event for any man, presenting both physical and psychological devastating effects. The different levels of penile amputation in an individual can define their ability to micturate and to concretize sexual intercourse, which directly impairs their virility and sexual performance and thus their psychological well-being. All this finally justifies any reconstructive effort that can be offered in order to improve the patient's quality of life. The free radial forearm flap has been considered for many years the gold standard in penile reconstruction as it has demonstrated good functional and aesthetic results. This microsurgical technique represents a great reconstructive advance, which results in a rescue of the patient's self-esteem and masculinity with a significant improvement in his quality of life. The authors present the clinical case of a 35-year-old male patient who required an almost total amputation of the penis, secondary to a severe electrical burn and who subsequently underwent the first microsurgical penile reconstruction with a free radial forearm flap in Costa Rica.

Surgical closure of postlaryngectomy pharyngocutaneous fistula: a defect-based approach

Postlaryngectomy pharyngocutaneous fistula [PCF] is a serious potentially life-threatening complication. Although most can be managed conservatively, some persist requiring surgical repair that can be sometimes challenging. Several studies describe separate reconstruction methods, however, only few address the variability in defect characteristics and hence appropriate flap selection. This study was conducted on 19 patients who underwent surgical repair of persistent PCFs, over a three-year period. Patients included 18 males [94.7%] and only one female [5.3%] with a mean age of 61 +/- 10 years. Nine patients had previous unsuccessful attempts for surgical closure. All patients had more than one comorbid condition predisposing to PCF development as ivell as preventing its healing. Previous neck irradiation was the most common [52.6%], followed by low hemoglobin level [47.4%], hepatic disease [36.8%] and diabetes mellitus [31.6%]. According to defect characteristics; 6 patients received a local cervical skin procedure [cervical skin turn-in [Z-plasty], 10 patients had reconstructions using the pectoralis major musculocutaneous flap with or without cervical skin turn-in hinge flaps for mucosal closure reinforcement and 3 patients required a radial forearm free flap repair in which its central part was de-epithelialized and the flap was folded on itself for both mucosal defect closure and external skin coverage. All PCFs were eventually successfully closed with no major complications. Acceptable oral swallowing results were achieved in all but one patient. This article describes the author's approach for surgical management of persistent PCFs with special emphasis on defect characteristics that affect reconstruction choice and hence closure outcome