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The Methodist Center for Restorative Pelvic Medicine
6550 Fannin Street
Houston, TX 77030
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Wounds that occur during trauma or after radical resection for cancer or other severe infection can lead to complex wounds of the perineum, vulva, penis or scrotum. Often, reconstruction is required for the patients to fully recover. Coverage and/or reconstruction will depend on the actual size of the wound as well as the availability of local tissue (or flap). A skin graft that takes flaps from the thigh or pubis region is one option for wound coverage. Skin grafts are used to cover large, shallow wounds and do not require radiation therapy.
For more complex wounds, surgeons need to use vascularized flaps for reconstruction. Vascularized flaps borrow additional blood vessels for the wound allowing for a greater capacity to heal. The flaps take advantage of the local laxity (slackness) to cover the wounds.
For deeper wounds, a musculocutaneous flap may be required for coverage. Musculocutaneous flaps pull muscle, skin and blood vessels from the donor site to the wound. Muscle flaps are taken from the inner thighs (gracilis flap), the back of the thighs (posterior thigh flaps) or the abdominal area (rectus abdominis flaps).
The difference between skin grafts and ‘free’ flaps is that free flaps are taken from distant parts of the body to cover large and complex wounds. These free flaps require microsurgery, reconnecting the arteries and veins under a microscope to reestablish blood flow and nourishment to the area. Sensation can also be restored with the use of microsurgery.