Aesthetic Penoscrotal Resurfacing: Creating Propeller Flaps from Gluteal Folds  So-Eun Han, Eun-Ji Kim, Hyun Hwan Sung, Jai-Kyong Pyon  European Urology  Volume 73, Issue 4, Pages 610-617 (April 2018) DOI: 10.1016/j.eururo.2016.09.033 Copyright © 2016 Terms and Conditions

Fig. 1 Schematic illustration of internal pudendal artery perforator (IPAP) gluteal fold flaps. The internal pudendal artery originates from the internal iliac artery in the pelvis, runs through the sacrotuberous ligament, and emerges into the ischiorectal fossa. The IPAP gluteal fold flap was designed based on marked perforators. To take into account the optimal closure scar for the donor site, the long axis of the flap is centred on the gluteal fold. European Urology 2018 73, 610-617DOI: (10.1016/j.eururo.2016.09.033) Copyright © 2016 Terms and Conditions

Fig. 2 (A) An example of less than ideal scar orientation, where the scar does not exactly coincide with the gluteal fold (case 4). (B,C) Distal tip necrosis developed in case 7 and the wound healed well spontaneously. Because a split-thickness skin graft was performed in the suprapubic and penile area intraoperatively, the patient was dissatisfied with the final aesthetic outcome. However, a relatively good aesthetic scrotal pouch was noted at 16-mo postoperative follow-up. (D) Anterior and (E) posterior appearance at 13 mo after surgery (case 9). These images show natural scrotal pouch formation and well hidden, less visible scars in the gluteal folds. European Urology 2018 73, 610-617DOI: (10.1016/j.eururo.2016.09.033) Copyright © 2016 Terms and Conditions

Fig. 3 (A) A 59-yr-old patient presented with extramammary Paget's disease of the penis and left scrotum. After complete excision, a penoscrotal defect of 15cm × 15cm in size developed. An internal pudendal artery perforator flap of 15cm × 10cm in size was designed along the gluteal fold. (B) Appearance of the penoscrotal defect immediately after reconstruction. The penile skin defect was covered with a split-thickness skin graft. (C) Lateral and (D) anterior appearance at 18-mo postoperative follow-up. European Urology 2018 73, 610-617DOI: (10.1016/j.eururo.2016.09.033) Copyright © 2016 Terms and Conditions

Fig. 4 (A) A 55-yr-old patient presented with extramammary Paget's disease. After complete excision, the defect size was 20cm × 20cm, including the penis and scrotum. (B) An internal pudendal artery perforator flap of 15cm × 7cm in size was designed along the gluteal fold bilaterally for near-total scrotum coverage. (C) Anterior and (D) midline scrotum raphe appearance at 10-mo postoperative follow-up, confirming that reconstruction led to a natural scrotum pouch. (E) Bilateral donor site scars in acceptable locations in the buttock creases. European Urology 2018 73, 610-617DOI: (10.1016/j.eururo.2016.09.033) Copyright © 2016 Terms and Conditions