Turnover Flap of External Rectus Sheath as Autologous Graft for Correction of Scrotal Hernia in Rams

Abstract

The aim of this study was to evaluate the outcomes of external rectus sheath (ERF) turnover flap with and without platelet-rich plasma (PRP) for reconstruction of large scrotal hernia in ram. Thirteen baladi rams suffered from large sized unilateral voluminous scrotal swelling were used in this study. All rams were randomly divided into two groups according to the type of surgical interference; group ERF (n=6) were subjected to surgical correction by external rectus sheath turnover flap and group ERF-PRP (n=7) were subjected to surgical correction by ERF with PRP. The scrotal hernia was successfully reduced, and the graft turnover procedure was easily carried out in all rams in both groups. Clinical assessment of pain and heat in ERF-PRP depicted the lowest score at all time points compared to ERF group. Hematological analyses showed significant changes in white blood cells (WBCs), neutrophil, lymphocytes, eosinophils, basophils count, serum amyloid A (SAA) , haptoglobin (Hp), tumor necrosis factor-α (TNF-α) and interlukin-1β (IL-1β) in ERF-PRP group (lower) when compared to ERF group at days 3 and 7. Ultrasonographic examination of all rams in the ERF and ERF-PRP groups showed that the graft was secure and correctly positioned. Ultrasound color doppler recorded higher vascularity in ERF-PRP in the form of a high-color signal at lateral margin of turnover flap at days 7, 21 and 35-days post-operative. Conclusively, autologous grafting with external rectus sheath flap with PRP, is a simple procedure, with low cost, fewer adhesion and no short-term complications.