Medial Thigh Flap as Salvage of a Long Perineal Urethral Strictural Defect

Abstract

Reconstructive urologists face substantial hurdles when dealing with complex or long-segment urethral strictures with considerable spongiofibrosis, especially when conventional methods like buccal mucosal grafts or penile skin flap substitutions are not definitive. We present a case report in which we employed an adipofascial pedicled upper medial thigh (AMT) flap as a single-stage procedure, with a successful outcome. A 40-year-old male patient with a 10-year history of recurrent urethral stricture presented with a 6-cm-long bulbar urethral defect. We employed a transverse upper medial thigh adipofascial pedicled flap to repair the defect. The flap was raised with preserved internal and external iliac-based dual vascular supply and tunneled to the perineum. The postoperative course was satisfactory, with stable flap integration and acceptable urinary flow. Compared with other substitutions, the upper medial thigh adipofascial pedicled flap demonstrates superior tensile strength, minimizing postsurgical ischemic complications, especially on a compromised urethral bed where conventional grafts are suboptimal. The AMT flap represents a promising, single-stage reconstructive option for necrosed bulbar urethral strictures. While we had promising results, refinement using a perforator-based propeller flap may reduce bulkiness and morbidity with the flap’s secured vascularity.