Vascularisation of Urethral Repairs with the Gracilis Muscle Flap
A 76-year-old man had a previous radical prostatectomy and ultra-low anterior resection for prostatic and rectal carcinoma. He developed tumour recurrence at the puborectalis with involvement of the posterior wall of the bladder. Further perineal dissection with wide margins resulted in a small defect at the previous urethral-bladder neck junction. This was repaired primarily but complicated by a urethrocutaneous fistula with recurrent urinary leak. The fistula was excised, and the urethral defect was repaired primarily. A pedicled gracilis flap was raised as an onlay over the suture line. The wound was closed primarily after local advancement of the surrounding tissue. The perineal wound healed well, and there was no contrast leak on the MCU performed 3 months postoperatively.