Lotus Petal Flap Urethroplasty
The lotus petal flap harvests bilateral pedicled fasciocutaneous flaps from the gluteal fold (perineal crease) based on perforators of the internal pudendal artery, in a petal-like configuration that provides vascularized tissue for perineal and panurethral reconstruction. Originally described by Yii and Niranjan in 1996 for vulvoperineal reconstruction,[1] its application to male perineal urethral reconstruction provides reliable coverage of complex defects, building on the pudendal-thigh flap concept.[2] The bilateral design allows large-volume tissue transfer with primary donor-site closure.
For the foundations-level deep dive on lotus petal flap anatomy, design variants (Warrier-thinned, Bodin supra-fascial, tunneled, IPAT), evidence base, and indications across vulvoperineal, ELAPE, scrotal, and male-perineal reconstruction, see Lotus Petal Flap (foundations).
Indications
Use this urethral atlas page for the narrow male-perineal / urethral-salvage role. The canonical anatomy and broader vulvoperineal evidence live on the foundations lotus petal flap page.
| Scenario | Why lotus petal helps |
|---|---|
| Complex perineal urethral reconstruction with skin / soft-tissue loss | Brings vascularized gluteal-fold fasciocutaneous tissue into a hostile perineum |
| Panurethral or staged salvage when local penile / scrotal skin is poor | Provides local-regional coverage without free-tissue transfer |
| Fournier's or necrotizing soft-tissue loss involving perineum / scrotum | Can resurface and bulk the perineoscrotal defect |
| Need for sensate, pliable, hidden-scar coverage | Gluteal-fold donor site closes primarily and hides in the crease |
Technique Overview
The flap is designed along the gluteal fold / perineal crease over the internal-pudendal-artery perforator territory. It can be advanced, transposed, or used as a propeller-style fasciocutaneous flap depending on defect geometry. For urethral work, the flap is usually a coverage and vascularized-bed solution, not the luminal urethral lining itself; oral mucosa, skin graft, or a staged plate supplies the epithelial surface when needed.
Key Steps
- Define the urethral repair first: graft, staged plate, perineal urethrostomy, or fistula closure.
- Map the soft-tissue deficit and decide whether one or bilateral lotus petals are required.
- Design the flap in the gluteal fold so the donor scar remains hidden and closure is tension-free.
- Raise the fasciocutaneous flap with enough perforator-bearing tissue to protect vascularity.
- Rotate / advance the flap into the perineal defect without kinking the pedicle.
- Inset around the urethral reconstruction without compressing the new lumen.
- Drain dead space and protect the repair with urinary diversion appropriate to the urethral operation.
Outcomes & Evidence
Most outcome data come from vulvar, ELAPE, and perineal reconstruction rather than urethroplasty-specific series. The useful transferable signals are reliability, hidden donor scar, low total flap-loss rate, and ability to close moderate perineal defects without microsurgery. Urethral outcomes still depend on the underlying urethral reconstruction: graft take, fistula closure, stricture recurrence, and urinary diversion strategy.
See Also
- Lotus Petal Flap
- Singapore / Pudendal-Thigh Flap
- Propeller Flap
- Scrotal Flap Reconstruction
- Propeller Flap Urethroplasty
References
1. Yii NW, Niranjan NS. "Lotus petal flaps in vulvo-vaginal reconstruction." Br J Plast Surg. 1996;49(8):547–54. PMID: 8976747
2. Wee JTK, Joseph VT. "A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report." Plast Reconstr Surg. 1989;83(4):701–9. PMID: 2648186