The Application of Muscular, Myocutaneous, and Fasciocutaneous Flaps as Adjuncts in Complex Refractory Urethral Disorders

  • Leonard N. ZinmanEmail author
  • Jill C. Buckley
Part of the Current Clinical Urology book series (CCU)


Simple wounds, fistulas, strictures, and tissue loss can be readily managed by appropriate tension-free approximation of unaltered wound edges with or without local random flaps. A number of local and systemic factors, however, transform these readily managed wounds into complex challenging conditions with poor outcome. Size, location, infection, radiation, reoperative hypovascular fibrosis, steroids and immunocompromising drugs, and vascular disease impact on wound care. With the advent of the axial muscle and fascial flaps, regional transpositions of peninsular flaps have dramatically changed our ability to restore the stability of wounds and the rescue of an anatomic region. These tissue transfer techniques have been underutilized in genitourinary reconstruction over the past two decades in the care of refractory radiation and inflammatory and reoperative pathology of the urethra, bladder, rectum, and perineum. This chapter reviews our experience with gracilis, gluteus, rectus abdominis, and Singapore flaps in refractory stricture and fistulas that defy conventional options. Experimental and clinical studies have confirmed the role of muscle surface in wound healing demonstrating superior resistance to bacterial inoculation in the presence of viable muscle, compared to random flaps and altered wound edges. These appropriately selected muscular and fascial flaps separate suture lines, support hypovascular fibrotic wound edges, protect grafts in adverse settings, and fill dead space injuries adjacent to wound. The adjuncts of axial muscular and fascial flaps in challenging complex perineal wound and fistulas closure have had a profound impact on outcome in our experience.


Necrotizing Fasciitis Muscle Flap Rectus Sheath Urethral Stricture Gluteus Maximus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of UrologyLahey ClinicBurlingtonUSA
  2. 2.Department of UrologyUniversity of California – San DiegoSan DiegoUSA

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