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Mirastschijski et al. Plast Aesthet Res 2020;7:45 Plastic and
DOI: 10.20517/2347-9264.2020.14 Aesthetic Research

Original Article Open Access

Midline raphe scroti artery flap for penile shaft
reconstruction

Ursula Mirastschijski , Carla Schwenke , Igor Schwab , Andreas Buchhorn , Andreas Schmiedl 5
3
1,2
4
5
1 Mira-Beau gender esthetics, Berlin 10777, Germany.
2 Wound Repair Unit, CBIB, Faculty of Biology and Chemistry, University of Bremen, Bremen 28359, Germany.
3 Department of Urology, Josef-Hospital, Delmenhorst 27753, Germany.
4 Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Bremen-Mitte, Bremen 28205, Germany.
5 Institute of Anatomy, Hannover Medical School, Hannover 30625, Germany.
Correspondence to: Prof. Dr. Ursula Mirastschijski, Wound Repair Unit, CBIB, Faculty of Biology and Chemistry, University of
Bremen, Leobener Str./NW2, Bremen 28359, Germany. E-mail: mirastsc@uni-bremen.de

How to cite this article: Mirastschijski U, Schwenke C, Schwab I, Buchhorn A, Schmiedl A. Midline raphe scroti artery flap for
penile shaft reconstruction. Plast Aesthet Res 2020;7:45. http://dx.doi.org/10.20517/2347-9264.2020.44

Received: 20 Mar 2020 First Decision: 20 Jul 2020 Revised: 26 Jul 2020 Accepted: 4 Aug 2020 Published: 21 Aug 2020

Academic Editor: Marlon E. Buncamper Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: To investigate a novel method for penile shaft reconstruction.

Methods: Penile tissue loss is caused by injury, infections, obesity or cancer resection. Reconstructive techniques
comprise skin grafts with the risk of scarring and tissue rigidity. To develop an alternative reconstructive procedure,
the pertinent vascular anatomy was studied on fresh cadavers instilled with red latex, which permitted the design
of the midline raphe scrotal artery flap (MiRA). After anatomical proof-of-feasibility, penile reconstruction was
performed in adult patients with classic buried penis or after cancer resection.

Results: Anatomical studies revealed a novel finding of two scrotal septa, each with the terminal branch of the
internal pudendal artery. Pedicled on both arteries, a neurovascular island flap could be harvested. In the presence
of excess scrotal tissue, the entire circumference of the penile shaft could be covered by this flap. Patients
with penile skin defects and excess scrotal tissue were eligible for flap harvest. The flap was raised either as an
extended island flap pedicled on both septal arteries for complete penile shaft coverage, or as a VY-flap for partial
reconstruction; the donor site was closed primarily. Post-operative complications included swelling or partial
wound dehiscence. There were no flap losses or perfusion problems. Patients reported full sensitivity to the penile
shaft skin and sufficient skin elasticity for erection.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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