INGUINAL LYMPHADENECTOMY AND PRIMARY GROIN RECONSTRUCTION USING RECTUS-ABDOMINIS MUSCLE FLAPS IN PATIENTS WITH PENILE CANCER

Objectives. The use of deep inferior epigastric artery (DIEA) rectus a bdominis muscle flaps in conjunction with inguinal lymphadenectomy to treat patients with squamous cell carcinoma (SCC) of the penis having high-volume inguinal lymph node metastases causing skin breakdown and secondary infection is described. Methods. Three patients with invasiv e SCC of the penis who had extensive unilateral inguinal nodal metasta ses with skin breakdown and secondary infection underwent pelvic lymph adenectomy and attempted wide resection of the superficial and deep in guinal lymph nodes. One patient had unresectable deep inguinal metasta ses and received postoperative radiation therapy. A DIEA rectus abdomi nis muscle flap was utilized to close the resulting groin defect. Resu lts. Pathologic analysis demonstrated no pelvic lymph node metastases in any of the patients, superficial inguinal lymph node metastases in I,and superficial and deep inguinal lymph node involvement in 2. All w ounds healed well. The 2 patients with deep inguinal metastases experi enced local disease progression. One patient died 7 months postoperati vely of complications from chronic renal failure but had no evidence o f tumor recurrence or wound problems. Another patient died of recurren t disease. Conclusions. A rectus abdominis muscle flap may be a useful adjunct for managing certain patients with penile cancer and extensiv e suppurative inguinal lymph node mestastases.