Scrotal Reconstruction Research Articles

Clinical and Biochemical Profile of Patients with 46, XY Disorders of Sex Development

Abstract Background Disorders of sex development (DSD) comprise a wide range of conditions with varying features and pathophysiology that most often present in the newborn or the adolescent. Affected newborns are born with ambiguous genitalia, whereas adolescents present with atypical sexual development during the pubertal years. Aim of the Work To study the clinical and biochemical profile of patients with 46, XY disorders of sex development. Patients and Methods This was a descriptive study, conducted on 50 patients with 46, XY DSD attending the Pediatric Endocrinology clinic, Children's Hospital, Ain Shams University were recruited from April 2019 till April 2020. Results In our study 88% of cases were reared as males, while 12% were reared as females. The mean age at diagnosis was 2.48 ± 1.33 years with a range of 1-7 years. Parental consanguinity was present in 28 (56.0%) patients and a positive family history in 10 (20.0%). Mean external masculinization score (EMS) in our study was 3.30 ± 1.81 and ranged from 0 to 9 with a median of 3. The mean of stimulated Testosterone / Dihydrotestosterone (T/DHT) ratio was 17.5 (7.8-26) and ranged between 1.5 and 66.6. The median of Anti Mullerian Hormone (AMH) was 56 ng/ml and ranged between 19.08 and 105 ng/ml. There was correlation between EMS final score and stimulated DHT (r = 0.54, P = 0.000). Of note 6 (12.0%) patients had reconstruction of scrotum, 7 (14%) had undergone inguinal hernia repair, 12 (24%) had undergone correction of hypospadias, 6 (12.0%) bilateral gonadectomy,6 (12.0%) left orchiopexy, 3 (6.0%) right orchiopexy and 10 (20%) bilateral orchiopexy. Conclusion Due to the overlapping clinical and biochemical parameters in various subsets of DSD, only a preliminary etiological diagnosis can be made in some cases. Genetic examination with long-term follow-up are needed for a precise diagnosis. Management of these patients is multidisciplinary which needs an endocrinologist, gynecologist, psychologist, pediatrician, and clinical geneticist.

Scrotal Elephantiasis in a 14-year-old Child

Background: Scrotal elephantiasis is a rare condition, especially in non-endemic regions. This case is novel due to its presentation in a young patient without infectious or hereditary causes, highlighting the need for awareness and tailored surgical approaches in similar scenarios. Case Presentation: A 14-year-old male presented with an 11-year history of progressive scrotal enlargement, causing significant physical impairment. Clinical examination and ultrasound confirmed scrotal elephantiasis. Surgical resection and reconstruction were performed, involving excision of excess tissue and subsequent scrotal reconstruction. Postoperative care included wound management and physiotherapy. The patient recovered well, with satisfactory aesthetic and functional outcomes, allowing a return to normal activities. Conclusion: This case underscores the importance of early diagnosis and individualized treatment strategies for scrotal elephantiasis. It demonstrates that successful surgical intervention can significantly improve quality of life in pediatric patients, providing a reference for similar cases in non-endemic regions.

Posttraumatic Scrotal Reconstruction with a Pedicled "Extended" Superficial Circumflex Iliac Artery Perforator Flap: A Case Report.

The superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been used for scrotal reconstruction after Fournier's gangrene, skin cancer, or infections. However, there are few publications with regard to penoscrotal reconstruction after a traumatic injury with this flap. In this article, we propose a new SCIP flap variation, the "extended" or "direct" SCIP flap, to effectively reconstruct a wide scrotal defect after a traumatic injury. The "extended" SCIP flap is designed medial and cranial to the anterosuperior iliac spine (ASIS) using the superficial branch of the SCIA as the main pedicle.

Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction.

This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The unique anatomy of the scrotum, vital for thermoregulation and spermatogenic function, necessitates reconstruction with thin and pliable tissue. When the scrotal defect area is less than half the scrotal surface area, scrotal advancement flap can be performed. However, for larger defects, some type of transplantation surgery is required. Various options are explored, including testicular transposition, tissue expanders, split-thickness skin grafts, local flaps, and free flaps, each with merits and demerits based on factors like tissue availability, defect size, and patient specifics. Also, physicians should consider how testicular transposition, despite its simplicity, often yields unsatisfactory outcomes and impairs spermatogenesis. This review underscores the individuality of aesthetic standards for scrotal reconstruction, urging surgeons to tailor techniques to patient needs, health, and defect size. Detailed preoperative counseling is crucial to inform patients about outcomes and limitations. Ongoing research focuses on advancing techniques, not only anatomically but also in enhancing post-reconstruction quality of life, emphasizing the commitment to continuous improvement in scrotal reconstruction.

Value of V-Y Advancement Flaps in the Coverage of Cutaneous Loss of Substance

Objective: We aimed to provide an update and highlight the value of V-Y advancement flaps in the management of cutaneous loss of substance (LOS). Methods: We included 18 patients in whom cutaneous reconstruction was performed at various sites between 2019 and 2021. Skin coverage was provided by means of unilateral or bilateral VY advancement flap. Among the 18 patients, 13 were men and 5 were women. The age of the patients ranged from 8 to 75, with an average age of 46.8. Perineal scrotal reconstruction was performed in 5 cases, sacral in 5 cases, plantar in 3 cases, ischial in 1 case, lumbo-gluteal in 2 cases, retroauricular in 1 case, and forearm in 1 case; 7 cases had bilateral V-Y advancement flap, while 11 cases had unilateral flap. We studied the indications, the size of the defect (4 cm × 5 cm to 20 cm × 30 cm), postoperative complications, and patient satisfaction. Results: No flap defatting was necessary. Long-term results in terms of scarring, functionality, and cosmetic appearance of the reconstructed area were considered satisfactory by the patients. Conclusion: Coverage of cutaneous LOS is a daily procedure for plastic surgeons. Since the V-Y advancement flap is a simple, useful, and reliable coverage technique with low morbidity, it should be an option in cutaneous reconstruction.

Bipedicled Scrotal Flap for Penile Resurfacing.

Acquired penile defects can be secondary to various pathologic conditions, including infection, scar, or complications following urologic procedures. Penis defects with skin deficit carry a distinct challenge for reconstructive surgeons. Scrotal flaps can provide reliable coverage and can restore distinct qualities of native penile skin. A series of patients presented with a variety of acquired penile defects. Each of these patients underwent staged bipedicle scrotal flap surgery for coverage by the senior author. Eight patients underwent bipedicle scrotal flap reconstruction for penile defects with a skin deficit. All eight patients had satisfactory outcomes postoperatively. Only two of the eight patients had minor complications. For select patients presenting with underlying deficit of penile skin, bipedicle scrotal flaps prove to be a safe, reproducible, and reliable reconstructive technique for penile resurfacing. Therapeutic, V.

SCROTAL CALCINOSIS: CASE REPORT AND REVIEW OF LITERATURE

Idiopathic scrotal calcinosis is a rare benign disorder of the scrotal skin. It consists of multiple nodules of the scrotal skin with no evident underlying cause, often with normal calcium and phosphate metabolism. The pathogenesis of scrotal calcinosis is still controversial. Metabolic and hormonal work-up needs to rule out other causes. Surgical excision is the choice of treatment both for conrming the diagnosis as well as for treatment. More studies need to be carried out on the best option for scrotal reconstruction

Scrotal reconstruction with bilateral gracilis muscle pedicled flap and split-thickness skin graft

Los defectos en la región escrotal son producidos en la mayoría de los casos por la gangrena de Fournier, y en ocasiones por traumatismo o patologías oncológicas.

Fournier’s gangrene reconstruction: A 10-year retrospective analysis of practice at Guys and St Thomas’s NHS Foundation Trust

Fournier's gangrene is a rare and potentially fatal condition that affects the external genitalia and perineum as a necrotizing soft-tissue infection. It is equally prevalent in men and women and although there are many ways to manage the condition, it must be done so effectively because there is a chance that life-threatening complications could develop. This retrospective study set out to fill any knowledge gaps, compare reconstructive options to those described in the literature, and promote reflection on current management. Between January 2010 and January 2020, all perineal debridement operation notes were examined. The primary conclusions were that a large majority of defects could be repaired using split skin grafts to reduce surgical time and donor site morbidity. To avoid secondary contracture and the need for revision surgery, full-thickness skin grafts should be used whenever possible to treat penile defects.

Complications and outcomes following injection of foreign material into the male external genitalia for augmentation: a single-centre experience and systematic review

Injection of exogenous material into the penis and scrotum has been performed for augmentation purposes. Complications include cosmetic dissatisfaction, penile necrosis and lymphoedema. We report the complications and outcomes from a single centre with an updated systematic review of the literature. A retrospective review of all cases presenting with foreign substance injection into the genitalia, over a 10-year period was performed. Thirty-five patients with a mean (standard deviation (SD); range) age of 36.9 (±9.1; 22–61) years at presentation were included. The mean (SD; range) time between injection and presentation was 7.8 (±5.8; 1 day–20 years) years. The most common injected substance was silicone (n = 16, 45.7%) and liquid paraffin (n = 8, 22.9%). The penile shaft (94.3%) was the most injected site. The most common presentations were cosmetic dissatisfaction (57.1%) and pain and/or swelling (45.7%). Surgery was required in 32 (91.4%) cases. Primary procedures included local excision and primary closure (n = 19, 59.4%), circumcision (n = 5, 15.6%), excision with a split skin graft or a scrotal flap reconstruction (n = 5, 15.6%). Three (8.6%) patients presented with necrosis and required acute debridement. Overall, 18 patients had more than 1 procedure, and 8 patients required 3 or more procedures. A systematic search of the literature identified 887 articles of which 68 studies were included for analysis. The most common substance injected was paraffin (47.7%), followed by silicone (15.8%). The majority of patients (77.9%) presented with pain, swelling or penile deformity. 78.8% of the patients underwent surgical treatment, which included excision and primary closure with or without the use of skin grafts (85.1% of all procedures), the use of flaps (12.3%) and penile amputation (n = 2). Complications of foreign body injection into the male genitalia can be serious resulting in necrosis and autoamputation. Surgical intervention is often required to excise abnormal tissue to manage pain and improve cosmesis.

Rare presentation of penile cancer: a case report

Penile cancer is rare. Squamous cell cancer usually starts on glans or coronal sulcus as a nodule, foul smelly ulcer or cauliflower like mass, which invades corpora cavernosa as it progresses sparing the urethra until late in the course of the disease.We report a case of 32-year-old male with squamous cell carcinoma of penis in the form of ulcer involving shaft of penis at the base with surrounding inguinoscrotal region managed with en-mass wide local excision of the malignant ulcer taking 1 cm margin from all sides with total penectomy with partial left scrotal skin excision with left orchidectomy with perineal urethrostomy with local scrotal advancement flap reconstruction with bilateral superficial inguinal lymphnode biopsy. Post op period was satisfactory. At discharge, flap was healthy with well-functioning perineal urethrostomy. Patienthad received 6 cycles of adjuvant chemotherapy.Ca penis can be present in any rare form and hence early diagnosis and timely management is the key.

An update on gender-affirming phallus construction using the radial forearm free-flap.

The history of phallus construction parallels the advances made in plastic and reconstructive surgery whereby the era of microsurgery revolutionized numerous techniques. In 1993, we reported our early experience in phalloplasty. While the originally presented technique was a modification of the original design reported by Chang and Hwang, we now present further modifications of the past 30 years. Through critical review of our technical modifications, as well as others', we present a comprehensive review of elements of the radial forearm free flap phallus construction. A radial forearm free flap is harvested and tubed to form the following components: urethra, shaft, and glans of the neophallus. When excess adipose tissue exists, the excess thickness is accommodated by increasing the proximal width of the flap. To optimize the venous drainage, the radial and ulnar superficial veins as well as the radial deep veins are included within the flap; however, venous flow is optimized through creation of an arteriovenous fistula within neo-glans. To lengthen the native urethra, labia minora and vaginal mucosal flaps are employed at a preliminary stage during vaginectomy. New coronoplasty modifications offer esthetic refinements. Updates in scrotal reconstruction and implantation of erectile devices complete the total genitourinary reconstruction. Phallus construction has evolved significantly over time. While numerous techniques exist, no standard of care has been identified. Continue surgical evolution will provide modern solutions for problems most often encountered to improve overall outcomes for transgender and gender-diverse patients pursuing masculinizing genitourinary reconstruction.

Versatility of unilateral propeller groin flap for coverage of large scrotal defects and its impact on testicular function

BackgroundThere are many options for scrotal reconstruction, each having its own benefits and drawbacks. In the last years, the introduction of the propeller flaps gained great popularity, while the use of groin flap as propeller in scrotal reconstruction remains anecdotal, with only a few cases reported in the literature.ObjectivesIn this research, we study the versatility of unilateral propeller groin flaps in the reconstruction of large scrotal defects.Patients and MethodsThis study was done on 10 patients with scrotal defects who were admitted to the plastic unit of the general surgery department at Benha University Hospital from 2019 to 2021 for scrotal reconstruction.ResultsAll surgeries were successful with a mean operative time of 103.5 min, ranging from 90 to 130 min. All flaps survived well with no flap necrosis, and only one case showed flap congestion. Donor site healed well with the scar hidden in a natural crease, with no affection on the testicular functions.ConclusionsThe use of groin flap as a propeller allows for free movement and rotation of the flap, which allows for better coverage of a large scrotal defect with good vascularity, lesser complications, no need for further operations to separate the pedicle, and the lowest donor site morbidity.Level of evidenceLevel IV, therapeutic study

An Innovative Technique of Testicular Preservation in Fournier's Gangrene: Surgical Details and Illustration.

Fournier’s gangrene, which is a necrotizing fasciitis of the perineal region, requires prompt control of infection with emergent surgical debridement. The shameful exposure of gonads, which occurs following debridement, can cause both physiological and psychological impairment to the patient. These can be avoided by the use of this novel technique for testicular preservation.Following debridement of necrotic scrotal skin, this technique involves creation of inguinal pouch by blunt dissection and placement of the testes in the pouch created. Once healthy granulation tissue is achieved in the scrotal wound, closure of the scrotum is performed after bringing down the testes. The advantages of this technique include development of a relatively physiological position to preserve the testes before definitive reconstruction of the scrotum and the easy reproducibility of the technique.A holistic approach to management of Fournier’s gangrene should include resuscitation, administration of antibiotics, debridement, and scrotal reconstruction. However, the psychological impact of shameful exposure of the gonads must also be borne in mind during the management. Our technique represents one of the ways to reduce the stigma and discomfort associated with shameful exposure of the testes.

The "Sombrero-Shape" Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene.

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

Various Options for Scrotal Reconstruction: A Prospective Observational Study.

BackgroundScrotal defects in developing countries are common challenges for the reconstructive surgeon and hence this work has been done with the aim to compare the outcome, advantages and disadvantages of different modalities of scrotal reconstruction.MethodsThe prospective observational hospital-based study of reconstruction of scrotal defects following trauma and Fournier’s gangrene was done over a period of three years. Scrotal defect reconstruction was done in 35 patients by scrotal advancement flap, split thickness skin grafting, medial thigh flap, anterolateral thigh flap and groin flap keeping in mind the various indication of different modalities. The reconstructed scrotums were observed for flap survival and skin graft intake for seven to 10 days in the hospital and then were followed for three months in a follow-up clinic.Results and observationsThe mean age of our patients was 48.57±5.01 years. Most of the soft tissue defects of the scrotum were post-traumatic (83%). Scrotal reconstruction was done often by flaps and more frequently used flap for reconstruction of scrotum was scrotal advancement flap. All flaps and grafts survived well. Mean hospitalization time was highest for groin flap cover whereas mean operative time was highest for anterolateral thigh flap cover.ConclusionEvery case of scrotal defect needs an individual approach for scrotal reconstruction depending upon patient age, general condition of the patient, wound status, and the patient’s requirement.

Scrotal Reconstruction Using a Free Ulnar Forearm Flap: A Case Report

Scrotal defects requiring reconstruction may occur after trauma, cancer, or infection. To maintain good testicular function, the ideal scrotal temperature should be slightly lower than the abdominal temperature. However, large local flaps that are enough to cover the testes cannot be used in all patients. A 74-year-old man presented with scrotal and perineal tissue defects after undergoing debridement for Fournier's gangrene due to rectal carcinoma-induced perforation. The scrotal skin defect was reconstructed using a 22 × 10-cm-free ulnar forearm flap. The postoperative course was uneventful, and at the 14-month follow-up examination, the scrotal skin was found to be thin and pliable. Moreover, the donor site on the left forearm was in an acceptable state and no hand dysfunction due to contracture was observed. Based on our observations, we recommend that the free ulnar forearm flap might be an effective option for scrotal reconstruction, causing little donor site morbidity.

Common Modalities of Reconstruction for Scrotal Defects at a Tertiary Care Hospital in Eastern India: An Observational Study

Introduction: Scrotal reconstruction remains a challenging problem to the surgeons. The various techniques used for scrotal reconstruction includes residual tissue re-arrangement, skin grafts, pedicled and free tissue transfer. There is lack of unified approach to deal with the issue. Aim: To discuss the surgical techniques performed for scrotal reconstruction in a tertiary care centre along with its epidemiological factors. Materials and Methods: This observational descriptive study was conducted on 33 cases in a tertiary care centre located in Eastern India over a period of three years. Scrotal reconstruction was planned according to aetiology, defect size, associated co-morbidity and age of the patient. Evaluation to assess the efficacy of each procedure was done with patient’s satisfaction scoring. At the time of discharge, with simple four level Likert scale, patient’s satisfaction was assessed. Descriptive statistics was used and results were expressed in terms of frequency and percentage. Results: The mean age of the patients with scrotal defects was 48±15.98 years. Fournier’s gangrene (n=21) was the leading cause of scrotal defects followed by trauma (n=8). The most common scrotal defect size was 50-75% (n=12). The most common scrotal reconstruction performed was Pudendal artery flap (Singapore flap) (n=12). Donor site scar was limited and acceptable. Wound related complications detected clinically as partial tissue necrosis, was observed in two cases. Most patients were satisfied with the final outcome, assessed by Likert scale. Conclusion: Scrotal reconstruction should be performed taking in account its aetiology, associated comorbidity, age and the scrotal defect size. Aesthetically and psychologically, well planned flap is reliable and better in comparison to Split-Thickness Skin Graft (STSG) and most of the complications can be managed conservatively.

Scrotal calcinosis in a patient treated with isotretinoin: a rare entity

Scrotal calcinosis is a rare disorder characterized by multiple papules or nodules of calcification in the scrotal skin. The pathogenesis of this disease is poorly understood. The condition presents as several brown to yellowish asymptomatic nodules on the scrotum. Excision followed by scrotal reconstruction is the treatment of choice. It leaves a good cosmetic result with low chances of recurrence. Newer treatments, such as ablative lasers, have been proposed with very good results. We describe the case of a 28-year-old patient with a history of severe acne treated with oral isotretinoin that presented for scrotal nodules. On laboratory examination, hypercalcemia was found with normal phosphorus, parathyroid hormone, and vitamin D hormone levels. Hypercalcemia was linked to his isotretinoin therapy. Serum calcium concentrations normalized after cessation of isotretinoin and hydration. Because the patient refused surgery, a biopsy of the lesion confirmed the diagnosis of scrotal calcinosis. Then the patient was referred to a cosmetic laser center to treat his condition.

Scrotal reconstruction after Fournier's gangrene

Scrotal reconstruction after Fournier's gangrene