Coverage of circumferential penile shaft defects with the bipedicled scrotal flap: a case series

Abstract

Reconstruction of circumferential penile skin defects should address both cosmetic and functional concerns. Scrotal skin is an ideal replacement because its inherent elasticity allows erection. This characteristic also allows primary closure of the donor site. The purpose of this paper is to describe our use of a bipedicled scrotal flap and our modifications. Five patients (age range, 19 to 76 years) over the last 7 years underwent reconstruction of circumferential defects with this technique. The underlying pathologic condition was siliconoma/paraffinoma (n = 2), full-thickness burn (n=1), overly aggressive circumcision (n=1), and traumatic avulsion (n=1). Follow-up ranged from 2 to 6 years. A bipedicled flap was elevated from the scrotum and inset over either the dorsal or ventral aspect of the penile defect. Flap delay was carried out before final division at 3 weeks. The junction line on the penile shaft was designed as a Z-pattern which was off-center. Four patients healed uneventfully. One patient had flap tip necrosis due to insufficient delay, which resulted in mild ventral scarring. All were able to have normal erection. We have used the bipedicled scrotal flap in a staged manner for circumferential penile defects. The advantages of this technique were reliable coverage with an inconspicuous donor site, provision of expansile skin allowing normal erection and preservation of the penile–scrotal junction. The disadvantages were multistaged procedure, skin mismatch because of rugosity, and hair growth. Level of Evidence: Level V, therapeutic study.