BAES Scrotal flap: anatomical bases and usefulness in complex urethral reconstruction.

OBJECTIVE: To describe the anatomical characteristics and vascularization of the biaxial hair free scrotal flap (BAES-flap) and to detail its surgical application to reconstruction of the more complex urethral strictures. METHODS: We performed macro and micro anatomical dissections of the scrotum in 15 cryopreserved cadavers for the study of the arterial microvascularization of the BAES flap, and this anatomical knowledge has been implemented with the aim to improve the anterior and posterior urethra reconstructive surgical technique. For scrotal skin conditioning we performed definitive hair removal with the alexandrite laser. RESULTS: The BAES flap, thanks to its rich biaxial vascularization, its anatomical disposition over the urethral axis, and the suitable characteristics of hair free scrotal skin, has allowed us to perform successful one-step urethral reconstruction in complex cases such as panurethral disease, multioperated hypospadias, failed urethroplasties and obliterative stenosis. CONCLUSIONS: Detailed study of scrotal skin arterial vascularization is essential to design reliable and versatile genital skin flaps that result appropriate for the most complex reconstructive urethral surgery. The BAES scrotal flap complies with these requirements offering the patient a one step reconstructive option with a very satisfactory surgical experience over more than 20 years.

Colgajo escrotal "BAES": Bases anatómicas y utilidad en reconstrucción uretral compleja / BAES Scrotal flap: Anatomical bases and usefulness in complex urethral reconstruction

OBJETIVO: Describir las características anatómicas y la vascularización del colgajo escrotal biaxial depilado ("BAES-flap"), y detallar su aplicación quirúrgica en la reconstrucción de las estenosis uretrales más complejas. MÉTODOS: Se han realizado macro y microdisecciones anatómicas de la bolsa escrotal en 15 cadáveres criopreservados para estudiar la microvascularización arterial que posee el colgajo "BAES", y este conocimiento anatómico ha sido implementado con la intención de mejorar la técnica quirúrgica reconstructiva de la uretra anterior y posterior. Para el acondicionamiento cutáneo escrotal se ha empleado la técnica de depilación definitiva con láser de Alejandrita. RESULTADOS: El colgajo "BAES" gracias a su abundante vascularización bi-axial, a su disposición anatómica sobre el eje uretral y a las características idóneas de la piel escrotal depilada, nos ha permitido desde el año 1989 reconstruir con éxito la uretra en un tiempo quirúrgico en casos complejos como son la enfermedad panuretral, los hipospadias multioperados, las uretroplastias fracasadas y las estenosis obliterantes. CONCLUSIONES: El estudio detallado de la vascularización cutánea arterial es fundamental para diseñar colgajos de piel genital fiables y versátiles que resulten aptos para la cirugía reconstructiva uretral más compleja. El colgajo escrotal "BAES" cumple con estos requisitos ofreciendo al paciente una opción reconstructiva en un solo tiempo con una experiencia quirúrgica muy satisfactoria de más de 20 años

OBJECTIVE: To describe the anatomical characteristics and vascularization of the biaxial hair free scrotal flap (BAES-flap) and to detail its surgical application to reconstruction of the more complex urethral strictures. METHODS: We performed macro and micro anatomical dissections of the scrotum in 15 cryopreserved cadavers for the study of the arterial microvascularization of the BAES flap, and this anatomical knowledge has been implemented with the aim to improve the anterior and posterior urethra reconstructive surgical technique. For scrotal skin conditioning we performed definitive hair removal with the alexandrite laser. RESULTS: The BAES flap, thanks to its rich biaxial vascularization, its anatomical disposition over the urethral axis, and the suitable characteristics of hair free scrotal skin, has allowed us to perform successful one-step urethral reconstruction in complex cases such as panurethral disease, multioperated hypospadias, failed urethroplasties and obliterative stenosis. CONCLUSIONS: Detailed study of scrotal skin arterial vascularization is essential to design reliable and versatile genital skin flaps that result appropriate for the most complex reconstructive urethral surgery. The BAES scrotal flap complies with these requirements offering the patient a one step reconstructive option with a very satisfactory surgical experience over more than 20 years

Cirugía reconstructiva para residentes en Urología / Reconstructive surgery for residents in Urology

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Arteries of the scrotum: a microvascular study and its application to urethral reconstruction with scrotal flaps.

OBJECTIVE: To study scrotal microvascularization and apply the findings to the design of reliable skin flaps for reconstructive surgery of complex urethral or panurethral stenoses. MATERIALS AND METHODS: In 15 cryopreserved male cadavers, scrotal skin vascularization was explored using macro- and microdissections, and the scrotal sac made transparent using the Spalteholtz method. A meticulous descriptive analysis of the arterial network was conducted out in all cases to evaluate the number, distribution and anastomosis of the cutaneous arteries of the scrotum. RESULTS: Scrotal skin is irrigated by two main vascular systems, through the inferior external pudendal arteries and the perineal arteries, which branch into multiple scrotal arteries. These arteries are distributed in three cutaneous territories, two lateral and one central, which are widely inter-anastomosed. Each lateral territory receives an inferior external pudendal artery which accesses at the midpoint of the scrotal root and fans out to cover the entire corresponding hemiscrotum. The central cutaneous territory is vascularized through the branches of two main scrotal arteries which are a continuation of the perineal arteries and which access via the posterior face, running deeply on both sides of the septum. CONCLUSIONS: The special anatomical distribution of scrotal branches stemming from perineal arteries enables the construction of adequate reliable longitudinal median island scrotal flaps for the reconstructive surgery of panurethral stenosis, as profuse axial vascularization is ensured.