Scrotal Skin Loss Research Articles

Rat Bite As A Cause Of Significant Genital Injury: A Case Report

Rat bite is generally a rare form of animal bite suffered by humans. It is said to account for about 1-3% of all cases of animal bites to humans. Such bites commonly involve the limbs and rarely on the genitalia. Rat bite resulting in significant genital injury evidenced by scrotal skin loss with exposure of the testis has not been reported in the literature as far as the authors are aware. We hereby report the case of rat bite to the genitalia of an adult male with resultant significant injury.

Evaluation of Pedicled Medial Thigh Perforator Flap and Its Application in Loco-Regional Soft Tissue Reconstruction

Introduction: perineoscrotal defects represent a challenging problem in reconstructive surgery. Scrotal skin loss can occur following trauma, Fournier’s gangrene, post tumor excision, burns, etc. There are many techniques described in the literature for reconstruction of defects of scrotal skin. The pedicled medial thigh (PMT) perforator flap is a valuable reconstructive option. In its pedicled form, the experience is currently limited to a few case reports. Objective: the purpose of this study was to describe clinical applications of the pedicled medial thigh (PMT) perforator flap for reconstruction of loco-regional soft tissue defects. Patients and Methods: between June 2018 and June 2019, an experimental cadaveric study including two cadavers with four lower limbs was done in Al-Azhar University, Faculty of Medicine, Department of Anatomy and Embryology. A prospective cross-sectional study in which ten male patients with soft tissue defects or lesions that requires excision and reconstruction in perineum and scrotum received MTP flaps. All flaps were unilateral and the flap sizes ranged from 9-12 cm to 12-26 cm. Results: all flaps survived well, with the exception of partial wound dehiscence in two patients that was managed conservatively by frequent dressings and healed by 2ry intention. Conclusion: the medial thigh fasciocutaneous perforator flap offers a good option for Perineoscrotal defects. The flap provides a single stage, stable, well vascularized soft tissue coverage with no significant major complications, short hospital stay, appropriate range of motion, faster return to normal lifestyle and accepted aesthetic appearance.

Outcome of pudendal thigh flap in scrotal reconstruction and its effect on testicular function

Introduction Reconstruction of major scrotal defects represent a great challenge for surgeons. Although a lot of therapeutic methods have been established for the reconstruction of these defects, each technique has its own advantages and disadvantages. The pudendal thigh flap is an axial and sensate fasciocutaneous flap based on the terminal branches of the superficial perineal artery, which is a continuation of the internal pudendal artery (below the urogenital diaphragm). The data on the testicular function after reconstruction of cover for the testes have been rarely reported. In this study, follow-up of patients with pudendal thigh flap was done regarding esthetic outcome, functional outcome, and testicular function. Aim The aim of this study was to show the versatility and usefulness of posteriorly based pudendal thigh flap for scrotal reconstruction and to evaluate its effect on testicular function. Patients and methods A total of 19 flaps in 13 patients with major scrotal defects were subjected to reconstruction using posteriorly based pudendal thigh flap. The cause of scrotal skin loss was Fournier gangrene in nine cases, trauma in three cases, and animal bite in one case. Six patients underwent bilateral flap reconstructions, and seven patients underwent unilateral flap reconstructions. Results All 19 flaps survived completely with good color matching. The donor site was closed directly, and the scar was hidden in the inguinal crease. One patient had wound dehiscence in the donor site and required a secondary procedure for healing. Testicular function regarding spermatogenesis and hormonal functions showed nonsignificant changes 6 months and 1 year after flap coverage. Conclusion Posteriorly based pudendal thigh flap is a good option for reconstruction of major scrotal defects. This flap gives a wide coverage with excellent esthetic appearance of the scrotum, without any significant effect on testicular function.

Evaluation of scrotal reconstruction with thigh flap

Background: Scrotal skin can be lost in many ways. Partial loss of scrotum is easy to manage but major scrotal skin loss represents a significant challenge to the reconstructive surgeon. Although many techniques have been established for the treatment of major scrotal defects, each technique has its own advantages and disadvantages in specific situations.Objective: The aim of this prospective study was to evaluate the outcome of thigh fascio-cutaneous flap for reconstruction of major scrotal loss with exposed testis.Methods: This prospective study was done for 5 years extending from January 2012 to December 2016. In this period we reconstructed major scrotal defects of eight patients with antero medial and pudendal thigh fascio-cutaneous flap in Burn and Plastic Surgery department, Khulna Medical College Hospital. Total eleven thigh fascio-cutaneous flaps were used for reconstruction of major scrotal defects.Results: The mean patient age was 41 years (range 24 to 62 years). The aetiology of scrotal loss was Fournier's gangrene in 4 cases and trauma in 4 cases. Three cases had bilateral and five cases had unilateral flap reconstruction. The flaps allowed sensate coverage and took well. Primary donor site closure obviated the need for skin grafts in most of the cases, Complications were flap tip necrosis (12.50%) and minor wound infection (12.50%) which were treated conservatively. Donor site scar was limited and acceptable. The flap had good aesthetic appearance except in one fatty patient where the flaps were bulky.Conclusion: The study concluded that thigh fascio-cutaneous flap is very reliable for coverage of major scrotal defects.Bang Med J (Khulna) 2017; 50 : 13-17

Scrotal reconstruction and testicular prosthetics.

Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results.

Scrotal reconstruction with modified pudendal thigh flaps

Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumour excision, burns, etc. There are many techniques described in the literature including residual scrotal skin mobilization, skin grafts, pedicled and free flaps. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the literature. We used a modified pudendal thigh flap to reconstruct scrotal defects in five patients. This study describes the vascularity of the flap, technique of elevation and the inset of the flap. The elevation and particularly the insetting make it different from other flaps raised on this vascular network for scrotal reconstruction. This pedicled flap is robust, reliable, resilient and produces a neo-scrotum that looks natural in appearance, offers good-quality skin cover and cushion to the testes as well as protective sensation.

Anteriorly based pudendal thigh flap for scrotal reconstruction based on the deep external pudendal artery (DEPA) flap

Background Major scrotal skin loss represents a significant challenge for reconstructive surgeons. Although many therapeutic methods have been established for the treatment of such defects, each technique has its own advantages and disadvantages. A posteriorly based pudendal thigh fasciocutaneous flap at the perianal region has been described for reconstruction of genital organs, but an anteriorly based pudendal thigh fasciocutaneous flap has not been described for scrotal reconstruction.

Medial Thigh Fasciocutaneous Flaps for Reconstruction of the Scrotum following Fournier Gangrene

Sir: Reconstruction of the scrotum following loss of scrotal skin caused by Fournier gangrene or trauma remains a challenge for plastic surgeons. Several reconstructive options, including primary closure, skin grafting, and flaps, are available.1,2 We have attempted several techniques and now favor single-stage reconstruction of the scrotum with medial thigh fasciocutaneous advancement flaps for reconstruction after Fournier disease. The medial thigh fasciocutaneous advancement flap uses a triangular island of skin and subcutaneous tissue on the proximal aspect of the medial thigh. The dimensions of the flap vary according to the defect's requirements and can be safely measured up to 6 × 15 cm. The flap to cover the scrotal defect is raised distally, advanced cephalad, and rotated medially toward the inguinal canal (Fig. 1) to create an ipsilateral hemiscrotum. Performing this maneuver bilaterally allows for creation of a new scrotum with both flaps sutured together, creating a new midline raphe (Fig. 2). The defects on the donor sites are closed primarily in layers. A drain is left in place for 2 or 3 days. The senior author has performed scrotal reconstruction with the medial thigh fasciocutaneous advancement flap on four consecutive patients in the setting of Fournier gangrene, with no flap loss and with excellent functional and cosmetic results.Fig. 1.: Rotation of a medial thigh fasciocutaneous flap to cover the testes.Fig. 2.: The final result, showing the new scrotum created by two flaps.Medial thigh fasciocutaneous flaps allow for a more natural appearing scrotum with less bulkiness than myofasciocutaneous or free flaps.2,3 A comparison of published techniques is offered in Table 1.1–5 Our clear preference is reconstruction with the medial thigh fasciocutaneous advancement flap.Table 1: Treatment Options for Scrotal Reconstruction after Fournier GangreneIn very obese patients, the medial thigh fasciocutaneous advancement flap should be avoided to prevent an excessively thick neoscrotum. Because the donor area is closed primarily, the medial thigh fasciocutaneous advancement flap results in less donor-site morbidity than other techniques. Also, the skin of the medial thigh provides an excellent color, hair distribution, and texture match. In our experience, the cosmetic results achieved with medial thigh fasciocutaneous flaps have been far superior to other techniques. Although a unilateral medial thigh fasciocutaneous advancement flap can be used, it is our preference to use bilateral flaps for cases of complete scrotal skin loss. This requires smaller flaps on each thigh, resulting in defects that can be closed primarily with ease. Also, the neoscrotum has a more natural appearance if it is created with bilateral flaps, resulting in a tension-free closure at the midline, imitating the scrotal raphe. Finally, having attempted both a proximally and a distally based flap, we would like to make known that we prefer the proximally (cephalad) based flap. It can be raised all the way to the inguinal ligament, rotated medially, and advanced without difficulty, allowing for a tension-free closure. We believe the advantages of the medial thigh fasciocutaneous flap for reconstruction of the scrotum after Fournier gangrene include improved and unparalleled cosmetic outcome, reestablishment of a near natural environment for the testes, and minimal morbidity in a technically uncomplicated, single-stage operation. DISCLOSURE The authors have no financial disclosures. Pirko Maguina, M.D. Division of Plastic, Cosmetic, and Reconstructive Surgery; University of Illinois College of Medicine at Chicago; Chicago, Ill. Karina L. Paulius, M.D. Department of Surgery; University of Illinois College of Medicine at Chicago; Mount Sinai Hospital Program; Chicago, Ill. Santosh Kale, M.D. Division of Plastic Surgery; Washington University School of Medicine; St. Louis, Mo. Ramasamy Kalimuthu, M.D. Division of Plastic, Cosmetic, and Reconstructive Surgery; University of Illinois College of Medicine at Chicago; Chicago, Ill.

Scrotal Reconstruction Using Rapid Intraoperative Tissue Expansion: A Preliminary Report

Extensive scrotal skin loss can pose a difficult management problem. In most cases delayed scrotal approximation is feasible due to the redundancy of scrotal skin. However, large defects usually require reconstruction using flaps or grafts. We present a novel technique of scrotal closure using rapid intraoperative tissue expansion to manage select extensive partial scrotal defects. Between January 1996 and April 2006, 3 patients underwent delayed closure using rapid intraoperative tissue expansion for approximately 75% scrotal skin loss. Intraoperatively the residual lateral scrotal and medial thigh skin, and subcutaneous tissues were dissected, creating bilateral cavities for the placement of round 300 cc tissue expanders. Gradual inflation for a total of 20 minutes allowed adequate tissue expansion of the 2 thigh flaps, enabling tension-free scrotal closure. Each patient was followed for 12 months. The resulting reconstruction provided a tension-free, cosmetically appealing scrotum with complete testicular coverage. There were no perioperative or postoperative complications. Although rapid intraoperative tissue expansion has been successfully used for the closure of facial and extremity defects, to our knowledge it has not been described for genital skin loss. Our experience suggests that this relatively simple method is a viable addition to the reconstructive armamentarium in a select group of patients with extensive scrotal skin defects that are not amenable to scrotal approximation alone.

Use of Tissue Expansion for Scrotal Sac Reconstruction After Scrotal Skin Loss

Use of Tissue Expansion for Scrotal Sac Reconstruction After Scrotal Skin Loss

Use of tissue expansion for scrotal sac reconstruction after scrotal skin loss

We describe a two-stage technique for scrotal sac reconstruction using tissue expansion, best described as a tissue expanded V- Y scrotoplasty. This technique has been used after extensive scrotal skin loss, providing excellent functional and cosmetic outcomes.