Z-Plasty for Sculpturing of the Bifid Scrotum

Abstract

Purpose Bifid scrotum is usually associated with scrotal and perineal Hypospadias. Conventional surgical repair includes rotation of two scrotal flaps joining them in the midline and vertical skin closure. On several occasions dimpling of the skin in the midline of the scrotum occurred, resulting in suboptimal aesthetic results. Herein we describe a surgical technique whereby the bifid scrotum is rebuilt and contoured using single or multiple z-plasties. Material and Methods We repaired 40 children with scrotal or perineal Hypospadias with varying degrees of bifid scrotum. Their ages ranged from 5 months to 6 years (average 3 years). Patients were divided into three groups: Group I (23 pts.): Children with primary perineo-scrotal Hypospadias who underwent two stage Hypospadias repair and had a z-scrotoplasty during either the first or second stage repair. Group II (11 pts.): Children who had previous Hypospadias surgery with a vertical scrotal midline closure and still had bifid scrotum. This group underwent secondary z-scrotoplasy. Group III (6 pts.): Children with primary posterior Hypospadias who had undergone midline vertical closure. Results Children in Group I (21/23pts) & Group II (11pts.) achieved excellent aesthetic results, with rounded scrotum, no midline dimpling, and no major complications. Midline dimple was encountered in 4/6 patients in Group III who had the vertical midline closure. Conclusions In repairing bifid scrotum associated with Hypospadias, the principle of z-plasty can be incorporated in scrotal contouring. It elongates, relaxes and interrupts the longitudinal tension of the midline closure. There are advantages to multiple small z-plasties over one large z-plasty, they avoid contracture and scar formation, which is apt to result in recurrence of the bifid scrotum.