Pedicled Superficial Circumflex Iliac Artery Perforator Flap for Salvage of a Chronic Postorchiectomy Genital Wound

Summary:

Chronic genital wounds following oncological surgery and radiation are uncommon and challenging to reconstruct because of scarred, poorly vascularized tissues and proximity to the urethra and testes. We report a 73-year-old man with a 2-year nonhealing wound at the base of the penis and right hemiscrotum after orchiectomy and adjuvant therapy. He presented for operative excision, skin substitute placement, and negative-pressure wound therapy. His early course was complicated by persistent venous oozing requiring ongoing hemostatic measures and subsequent operative debridement. Final pathology showed no malignancy recurrence. Given the extent of tissue loss and failed prior grafting, definitive coverage was achieved with a pedicled superficial circumflex iliac artery perforator (SCIP) fasciocutaneous flap with indocyanine green–confirmed perfusion and 2 Blake drains. The flap remained viable with excellent capillary refill. Postoperatively, he developed acute blood-loss anemia, transient acute kidney injury that resolved with medical optimization, and a medication-associated hypoxic event after prophylactic antibiotics, all managed without flap compromise. This case highlights decision-making for staged wound bed optimization, selection of a pedicled SCIP flap in a radiated field after skin grafting failure, and perioperative management considerations in an older patient with cardiovascular comorbidities. The SCIP flap provided durable, sensate coverage with favorable early outcomes, supporting its role as a versatile option for complex genital reconstruction when skin grafting is unlikely to succeed.