Plastic and Reconstructive Surgery, Volume 102, No. 4, pages 1075-1082.
September 1998

The Prepuce Free Flap: Dissection Feasibility Study
and Clinical Application of a Super-Thin New Flap

Paul M. N. Werker, M.D., Ph.D., Alex S. C. Terng, and Moshe Kon, M.D., Ph.D.

Utrecht, The Netherlands

The aim of this study was to develop a free flap of the male prepuce. First, a dissection feasibility study was performed on eight male cadavers. Dissection proved feasible, and the mean surface area of the prepuce when folded out, was 46.7 cm2. The mean pedicle length was 15 cm, with a mean diameter of the inferior external pudendal artery at its orgin of 1.2 mm and a mean diameter of the inferior external pudendal vein at its orgin of 1.9 mm. Next, a viability study was performed by isolating a prepuce free flap during male-to-female sex reassignment procedures. The flap as well as the residual skin of the penis shaft remained well perfused. Thereafter, the new prepuce free flap was successfully applied for the reconstruction of defects of the floor of the mouth, tongue, and oropharynx in two patients. The thinness and pliability of the flap, its large surface area, the long vascular pedicle, and the limited donor-site morbidity are the major advantages of the new flap. The possibility to raise the flap simultaneously with the tumor resection is an additional advantage. The small caliber of the flap artery seems to be the only drawback. (Plast. Reconstr. Surg. 102: 1075, 1998.)

CIRP NOTE: Prior to excision for the purposes of using the foreskin tissue for repair of oral cancers, the total surface areas of the inner and outer layers of the foreskins from two adult male patients were measured. Below are excerpts from the findings:


Case 1: "The proximal border of the prepuce skin island was determined while traction was applied on the penis. Its skin surface area measured 64cm2 (8.5 x 7.5)." CIRP NOTE: This equals approximately 10 square inches of tissue.

Case 2: "Subsequently, the prepuce flap was elevated, including again both the inner and outer layers of the prepuce. The flap's skin surface area was found to be 90cm2 (10 x 9 cm)." CIRP NOTE: This equals approximately 14 square inches of tissue.

From the Department of Plastic, Reconstructive and Hand Surgery at the University Hospital of Utrecht and The Laboratory of Functional Anatomy at Utrecht University. Received for publication August 21, 1997; revised November 25, 1997.
Presented in part at the 3rd Congress of the European Federation of Societies for Microsurgery in Berlin, Germany, April 17 through 19, 1996, at the Benelux meeting of Societies for Plastic Surgery in Mondorf-les-bains, Luxembourg, October 18 through 19, 1996, and at the Spring Meeting of the Dutch Society for Plastic Surgery in Arnhem, The Netherlands, April 4 and 5, 1997.

Cite as:
(File prepared 20 November 1998)

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