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Original Article Plastic and Aesthetic Research

Penoscrotal defect: a functional, esthetic,

and psychological challenge

Durga Karki, Pankaj Kumar Patel, Ravi Prakash Narayan

Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital, New Delhi 110029, India.
Address for correspondence: Dr. Durga Karki, Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital, New Delhi
110029, India. E-mail: dkarki10@yahoo.co.in

ABSTRACT
Aim: Penoscrotal defects may be caused by a variety of events. Reconstruction of the
penoscrotal region is required not only for aesthetic appearance but also for functional and
psychological reasons. Numerous techniques have been described for penoscrotal reconstruction
reflecting the challenge and complexity of the region involved. This suggests that no
single method is satisfactory for all types and degrees of tissue defects. This prospective
study was conducted in a tertiary care hospital in India, over a period of 5 years. Methods:
Eighteen patients with penoscrotal defects of varying etiology were included in the study
and underwent different surgical techniques. Age of the patients ranged from 20 to 60 years. The
etiology of penoscrotal defect was Fournier’s gangrene in 12 cases, trauma in 4 cases, and burn
in 2 cases. The patients with Fournier’s gangrene were initially treated by debridement,
drainage, and antibiotics. The penoscrotal defects were treated with local flap advancement
with skin grafting (n = 7), pedicled anterolateral thigh flap (n = 4), gracilis muscle flap with split
skin grafting (n = 4), and medial thigh flap (n = 3). Results: There was complete healing in 16
patients with minor complications in the form of partial skin graft loss (n = 1) and wound
dehiscence (n = 1). Results were highly satisfactory in 6 patients, satisfactory in 8 patients, and
not satisfactory in 4 patients. Scarring at the donor site was limited and acceptable. Conclusion:
The vast arsenal of options for penoscrotal defect coverage ranges from skin grafting to flaps, and
every case needs a customized approach with regard to its feasibility, outcome, and complication
rate. Flaps should be the preferred choice over the skin grafts because of the superior
functional and aesthetic results and better compliance.

Key words:
Anterolateral thigh flap; gracilis muscle flap; penoscrotal defect

INTRODUCTION complete loss of the overlying skin is a challenging
problem. The difficulty in the reconstruction of
[2]
Penoscrotal defects can be caused by road the scrotum lies in the fact that the blood supply to
traffic accidents, assaults, burns, animal bites, infection/ the scrotal skin is destroyed when the skin and
gangrene of the region (Fournier’s gangrene), postfilarial dartos muscle are avulsed or infected. Bacterial
[3]
surgeries, penoscrotal construction for congenital flora of the perineum, difficulty of immobilization,
agenesis, and gender reassignment surgeries.
[1]
Reconstruction of the penoscrotal region after a and contour of penis and testes makes the task of
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How to cite this article: Karki D, Patel PK, Narayan RP.
DOI: Penoscrotal defect: a functional, esthetic, and psychological
10.20517/2347-9264.2015.28
challenge. Plast Aesthet Res 2016;3:64-7.
Received: 12-03-2015; Accepted: 05-11-2015
64 © 2016 Plastic and Aesthetic Research | Published by OAE Publishing Inc.