The groin flap phalloplasty is a surgical procedure which uses a flap from your groin to construct a neophallus.
Groin flap phalloplasty is one of the most common methods of phalloplasty that creates a phallic shaft for transgender people.
The groin triangle is also known as the femoral triangle and is the region in your lower abdominal wall and more specifically in the groin area.
The groin triangle is also defined by the boundaries of the inguinal ligament, the adductor longus muscle and the sartorius muscle.
The groin triangle is significant clinically because it contains important blood vessels and nerves like the femoral artery and vein and is also a potential site for hernias.
The landmarks of the groin flap are.
Anterior superior iliac spine which is a bony landmark, pubic tubercle which is also a bony landmark, Inguinal ligament which is an axial portion of the flap, femoral artery which is a landmark that can be palpated, superficial circumflex iliac artery which is a landmark that runs parallel to an d2 to 3 cm below the inguinal ligament and the sartorius muscle which is a key landmark in dissection.
The markings for a groin flap are.
Anterior superior iliac spine (ASIS): Marked with an imaginary line connecting it to the pubic tubercle.
Inguinal ligament: The line between the ASIS and pubic tubercle corresponds to the inguinal ligament.
Flap width: One third of the flap is above the inguinal ligament and two thirds are below.
Pedicle: Marked 3 cm below and parallel to the inguinal ligament.
Superficial circumflex iliac artery (SCIA): Marked using a Doppler, the SCIA emerges from the femoral vessels about 2 cm below the inguinal ligament.
Sartorius muscle: Marked, including its medial aspect.
The markings for a groin flap are done by drawing a line between the pubic tubercle and the anterior superior iliac spine overlying the inguinal ligament.
The flap width is measured by the rule of thirds, 1/3 (or two fingerbreadths) above the line and 2/3 below, which is around 3 cm superior and 6 cm inferior to the inguinal ligament.
To raise a groin flap the surgeon will make an incision in your groin area and carefully dissect the tissue layer by layer from lateral to medial, while staying in the subfascial plane to access and preserve the superficial circumflex iliac artery which also serves as the blood supply for the flap.
The flap is then elevated while also ensuring to protect the lateral cutaneous nerve of the thigh throughout the process.
The way you divide a groin flap is by carefully dissecting along the length of the groin flaps pedicle, which essentially splits it into 2 separate flaps, while also meticulously preserving the main vascular supply running centrally within the flap and it also allows you to use each lobe of the divided flap to cover separate areas of a defect.
The splitting of the groin flap is performed along the longitudinal axis of the flap, along the same axis as the superficial circumflex iliac artery and vein.
The size of the groin flap is around 30 cm in length and 10 cm in width although the size of a groin flap can vary.
The average size of a free groin flap is 19 cm by 12 cm, with the smallest groin flap being 8 cm by 6 cm in size and the largest groin flap being around 27 cm by 17 cm.
The different types of groin flaps are.
Conjointed latissimus dorsi-groin flaps which comes in 4 different types which include.
Type I: Pedicled latissimus dorsi and free groin flap.
Type II: Free latissimus dorsi and pedicled groin flap.
Type III: Both pedicled flaps.
Type IV: Both free flaps.
McGregor flap.
The McGregor flap also known as the pedicled groin flap, this flap is used to reconstruct large tissue defects of the hand, wrist, and forearm.
It's a versatile flap which can be performed by less-experienced surgeons.
Tensor fascia lata, anterolateral thigh, and vertical rectus abdominis flap which are the most common flaps used for groin reconstruction.
They provide good soft tissue coverage, but they sacrifice a functioning muscle.
Island flap: Transferred under a tunnel.
Tubed pedicle flap: Transferred as a delay flap, requiring separation after 2–3 weeks.
The difference between a groin flap and a SCIP flap is an SCIP flap is a more refined version of the groin flap that only uses a single perforator branch from the superficial circumflex iliac artery perforator flap.
A groin flap is a traditional surgical flap which utilizes the entire superficial circumflex iliac artery as it's blood supply.
The axis of the groin flap is a finger breadth below the inguinal ligament and a line drawn from the point where the superficial circumflex iliac artery originates to the anterior superior iliac spine.
The superficial circumflex iliac artery is the axial vessel which supplies the flap and it runs along your inguinal ligament, usually around 2 cm below it's margin.
A groin flap is the vascularized flap of tissue from your groin area which is used to cover soft tissue defects.
A groin flap is based on the superficial circumflex iliac artery, which is a branch of your femoral artery which provides a blood supply that is relatively constant to a large area of your groin.
This relatively constant blood supply to a large area of the groin allows for a substantial amount of tissue to be used.
Reconstructive surgeons commonly use groin flaps to cover soft tissue defects on the hand and also the distal two thirds of the forearm.
Groin flaps can also be used to treat complex soft tissue injuries of the neck and head.
There are also severe different variations of the groin flap technique which includes a sensitive variant, tubular design and flat tissue coverage.
The donor site of a groin flap can also usually be primarily closed.
The complications of groin flap include.
Undermining the wound edges in the abdomen and thigh to enable a direct skin closure can result in a loss of sensation in this region.
Also a loss of feeling in the upper lateral thigh caused by transsection of the lateral femoral cutaneous nerve during dissec- tion of the groin flap is possible.
Skin grafts, in contrast to flaps, are completely removed from their blood supply, whereas flaps remain attached to a blood supply via a pedicle.
Skin grafts are less technically difficult but can be more time consuming as the procedure creates a second surgical site.
The two indications for the conjoined LD–groin flap are the need for extensive and long soft-tissue coverage or for reconstructing bone defects, restoring lymphatic system, and providing functional muscle transfer in one single flap.