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A Modified Bilateral Scrotal Flap for Penile Skin Defect Repair
In This Article
Summary
This study presents an application of the modified bilateral scrotal flap for the reconstruction of penile skin shortages and scar contractures.
Abstract
Skin shortages and scar contractures are common complications following penile trauma and tumor surgery, resulting in significant pain and erectile dysfunction. Currently, skin grafts and scrotal flaps are widely used to reconstruct skin shortages. However, various limitations still exist; for instance, the skin graft may cause severe scarring in patients, and the traditional scrotal flap usually requires a two-stage procedure due to the large skin defect.
To treat the shortage of foreskin, a modified bilateral scrotal pedicled flap is used. In this procedure, flaps located on each side of the midline of the scrotum, which was pedicled from the anterior scrotal artery, are harvested. Subsequently, these bilateral scrotal flaps, like a butterfly, can successfully cover the foreskin defect. In this study, seven patients underwent this procedure, and satisfactory outcomes were obtained. Only two patients developed necrosis in some small areas of the flaps, which were recovered after wound care. Postoperative penile length significantly increased compared to the preoperative status in both flaccid and erectile states. We believe that modified bilateral scrotal flaps are a simple and effective solution to penile skin shortages and scar contractures.
Introduction
Penile skin shortages often occur as a consequence of infections, trauma, burning, and surgical excision, owing to benign or malignant penile skin diseases1,2. Reconstructive surgery is a major treatment option for this disease with the ultimate goal of preserving cosmetic appearance as well as normal function by providing redundant skin envelopes to preserve the physiological girth and length expansion during erection and sexual intercourse2,3. For most surgeons, however, reconstructive surgery remains a challenge.
Currentl....
Protocol
The study was approved by the local Medical Ethics Committee of Shanghai Ninth People's Hospital in China. All the studies were conducted in accordance with the Declaration of Helsinki of the World Medical Association, and written consent was obtained from all patients.
1. Preparations for the surgery
- Evaluate patients through a detailed history assessment and a physical examination, comprising of pelvic magnetic resonance imaging, scrotal size measurement, and.......
Representative Results
Using the protocol described above, seven patients underwent the modified bilateral scrotal pedicled flap surgery. The median age, duration of disease, and length of the flap were 32 years (23-53 years), 7 months (3-12 months), and 12 cm (10-13 cm), respectively. Of these seven patients, only two developed necrosis in some small areas of the flaps but recovered after wound care. The necrosis of flaps is mainly caused by bad preservation of the superficial dartos and vascular supply. The length of the flap is not a contri.......
Discussion
Extensive loss of penile skin is troublesome and harmful to individuals16. The goal of reconstruction is to achieve a good aesthetic appearance of the penis and restore the extensibility of the foreskin. In most situations, STSG is preferred to cover the defect3,5. However, postoperative scarring and edema of the survival grafts sometimes result in unsatisfactory feedback. There have been reports of multi-stage operations, including the em.......
Acknowledgements
The authors thank the patient who kindly contributed and shared his disease experience for this article. The authors would like to acknowledge the support of the Project of biobank from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (YBKB202119), Medical Research Foundation of Shanghai Science and Technology Commission (20Y11904300), Cross-disciplinary Research Fund of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (JYJC201912) and Clinical Research Foundation of Shanghai Municipal Health Commission (202040437).
....Materials
| Name | Company | Catalog Number | Comments |
| 10Fr Suction drain (1) | Guanzhou Wellead Medical Co. | ||
| 18Fr silicone urethral catheter (1) | Guanzhou Wellead Medical Co. | ||
| 3-layered compress 30 cm x 45 cm (10) | According to surgeon's preference | 175260 | |
| Allis forceps 16cm | B.Braun | EA092R | |
| Allis forceps 20cm | B.Braun | EA095R | |
| Bard-Parker scalpel number 3 (1) | Jinzhong Medical Instruments | ||
| Bard-Parker scalpel number 4 (1) | Jinzhong Medical Instruments | ||
| Debakey forceps 16 cm (6) | Strong Medical Instruments | ||
| Debakey forceps 20 cm (2) | Strong Medical Instruments | ||
| Debakey needle driver 18 cm (1) | B.Braun Medical Instruments | BM035R | |
| Electrocauter blade 15 cm (1) | Hutong Medical Instruments | CO 150i | |
| Halsted-Mosquito (8) | Jinzhong Medical Instruments | ||
| Jones scissor 18 cm (1) | Strong Medical Instruments | ||
| Mayo-Hegar needle driver 20 cm (1) | B.Braun Medical Instruments | BM022R | |
| Mayo-Stille scissor 17 cm (1) | Strong Medical Instruments | ||
| Monopolar electrocauter Valleylab (1) | Medtronic | E2100 | |
| Nylexogrip 10cm x 4.5m (1) | Urgo | 1641486 | |
| Scalpel blade number 15 (1) | Jinzhong Medical Instruments | ||
| Scalpel blade number 24 (1) | Jinzhong Medical Instruments | ||
| Sterile drapes (4) | Medline | ||
| Sterile gloves (3 pairs) | medicom-china | ||
| Sterile gown (3) | According to surgeon's preference | NA | |
| Surgical compress 10 cm x 10 cm (10) | According to surgeon's preference | 232088 | |
| Surgical forceps 14 cm (2) | Jinzhong Medical Instruments | ||
| Urgostrapping 8 cm x 2.5 m (1) | Urgo | 696037 | |
| Vacuum flask 250 mL (1) | Guanzhou Wellead Medical Co. | ||
| Vicryl 3-0 wire (6) | Ethicon | VCP316H | |
| Vicryl 5-0 wire (2) | Ethicon | VCP433H | |
| Vicryl Rapide 3-0 wire (2) | Ethicon | VF2260 |
References
- Garaffa, G., Raheem, A. A., Ralph, D. J. An update on penile reconstruction. Asian Journal of Andrology. 13 (3), 391-394 (2011).
- Guo, L., et al. Utilities of scrotal flap for reconstruction of penile skin defects after severe....
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