Pelvic, Perineal, and Genitourinary Reconstruction — VRAM, Gracilis, Phalloplasty, and Fournier’s Gangrene

This episode reviews the core principles of pelvic, perineal, and genitourinary reconstruction, focusing on dead-space obliteration, radiation injury, flap selection, and functional restoration.Topics include pelvic and perineal embryology, internal versus external pudendal blood supply, pudendal nerve anatomy, and the reconstructive challenge created by APR, pelvic exenteration, rectal cancer, gynecologic cancer, radiation injury, and catastrophic infection. The episode emphasizes the “rigid bowl” problem of the pelvis, where dead space can lead to abscess, bowel obstruction, hernia, fistula, and chronic non-healing wounds.Major flap options are reviewed, including the VRAM flap, gracilis flap, Singapore/pudendal thigh flap, ALT flap, and posterior thigh/gluteal fold flaps. Key surgical principles include using healthy vascularized tissue in radiated fields, releasing the posterior rectus sheath below the arcuate line during VRAM harvest, preserving colostomy planning, avoiding unreliable distal gracilis skin paddles, maintaining sensation in pudendal thigh flaps, and strict postoperative offloading for gluteal-based reconstruction.Genitourinary reconstruction is discussed through hypospadias, epispadias, Peyronie’s disease, penile replantation, phalloplasty, scrotal reconstruction, and Fournier’s gangrene. Additional topics include Cordiero vaginal defect classification, Snodgrass repair, MAGPI, penile prosthesis timing, radial forearm tube-within-a-tube phalloplasty, temporary medial thigh pouches for exposed testes, tissue expansion, skin grafting, and local flap reconstruction of the scrotum. Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordspelvic reconstruction, perineal reconstruction, genitourinary reconstruction, APR reconstruction, pelvic exenteration reconstruction, rectal cancer reconstruction, vaginal reconstruction, Cordiero classification, VRAM flap, vertical rectus abdominis myocutaneous flap, DIEA, arcuate line, posterior rectus sheath release, gracilis flap, medial circumflex femoral artery, Singapore flap, pudendal thigh flap, ALT flap perineal reconstruction, gluteal fold flap, radiation injury, dead space obliteration, Fournier’s gangrene, scrotal reconstruction, medial thigh pouch testes, hypospadias, epispadias, Snodgrass repair, MAGPI, Peyronie’s disease, penile replantation, phalloplasty, radial forearm phalloplasty, tube-within-a-tube phalloplasty, vascularized composite allotransplantation