Vascularisation of Urethral Repairs with the Gracilis Muscle Flap
A 33-year-old man with type I diabetes mellitus presented with Fournier's gangrene. Debridement of the necrotic bulbar urethra resulted in a long ventral urethral defect extending from the distal penile urethra to 2 cm distal to the verumontanum. The urethral plate was intact and a penile skin flap urethroplasty was performed. A transverse segment of prepuce was harvested. It was pedicled on the superficial layer of the Buck's fascia. The skin and pedicle were divided ventrally, and the skin island was rotated and sutured to the urethral defect as a ventral onlay. Although there was sufficient skin coverage from local advancement, a right gracilis muscle was used as an onlay to reinforce the urethroplasty site. MCU performed 6 months postoperatively showed that the urethra was patent with no contrast leakage or stricture. He was followed up for 9 years.