title: Vertical rectus abdominis flap reconstruction in patients with advanced penile squamous cell carcinoma.
abstract: OBJECTIVE
  To evaluate the role of radical surgical debridement and excision with a vertical rectus abdominis myocutaneous (VRAM) flap reconstruction in patients with advanced penile cancer and subcutaneous metastatic disease, as the quality of life in such patients is extremely poor, multimodal treatments often fail and the outlook for the patient is limited with the development of uncontrollable disease.
  
  
  METHODS
  Four patients with advanced penile cancer presenting with fungating, cutaneous tumour deposits received palliative surgical resections for abdominal and inguinal disease. A VRAM flap was used in all cases to achieve tissue coverage.
  
  
  RESULTS
  All grafts were viable and the mean inpatient stay was 14 days. There were no immediate complications after surgery; patient satisfaction and symptom relief was excellent.
  
  
  CONCLUSIONS
  Aggressive palliative resection with a VRAM can dramatically improve the patients' quality of life in advanced penile cancer, permitting disease control with satisfactory cosmesis. However, a multidisciplinary approach involving both the urological reconstructive and plastic surgeon is essential.
authors.affiliation: Institute of Urology and Department of Plastic Surgery, Royal Free and University College Hospitals, London, UK.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Kayes
authors.forename: Charles A
authors.initials: CA
authors.lastname: Durrant
authors.forename: David
authors.initials: D
authors.lastname: Ralph
authors.forename: David
authors.initials: D
authors.lastname: Floyd
authors.forename: Simon
authors.initials: S
authors.lastname: Withey
authors.forename: Suks
authors.initials: S
authors.lastname: Minhas
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010412:Penile Neoplasms / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000592:standards*; D017568:Rectus Abdominis / Q000637:transplantation*; D013524:Surgical Flaps; D016896:Treatment Outcome