A Modified Bilateral Scrotal Flap for Penile Skin Defect Repair

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 diseases^1,2. 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 intercourse^2,3. 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

1. Evaluate patients through a detailed history assessment and a physical examination, comprising of pelvic magnetic resonance imaging, scrotal size measurement, and assessment of the severity of the scar (Figure 1A).
2. Ensure that the preoperative anesthesia risk assessment o....

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 defect^3,5. 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.......

Materials

List of materials used in this article

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