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[4]
peno-scrotal coverage difficult. Reconstruction of the end after dissection with preservation of the vascular
scrotum is required not only for cosmetic but also for pedicle present at the proximal part [Figure 2a-c]. The
functional and psychological reasons as well. Various dissected muscle was transferred over the defect and
surgical options have been described for penoscrotal passed through a subcutaneous tunnel [Figure 2d]. The
reconstruction including split skin grafting (SSG), burying transferred muscle was skin grafted, and the harvested
testis underneath the medial thigh skin, tissue expansion site was closed primarily [Figure 2e and f]. The operated
of adjacent tissues, use of local fasciocutaneous or patients were followed in our hospital at a regular interval
musculocutaneous flaps, and free flaps. The aim of this and were asked about the improvement on a global scale
study was to evaluate various reconstructive procedures of 1-10, ranging from not satisfied to highly satisfied. The
for penoscrotal defects. penoscrotal defect etiology was Fournier’s gangrene in 12
cases, trauma in four cases, and burn in two cases.
METHODS
RESULTS
A prospective study was conducted in a tertiary care
hospital over a period of 5 years from March 2009 to A total of 18 patients were identified, with a mean age
February 2014. The operated patients were reviewed on a of 45 years ranging from 20 to 60 years. The etiology
regular basis in context to the outcome of the procedures, included: 12 (66.6%) cases of Fournier’s gangrene,
complications, and further need for any intervention. 4 (22.2%) cases of traumatic injury, and 2 (11.2%) cases
Patients with penoscrotal defects of varying etiology and of burn injury. The defects were treated with local flap
who had been operated using different reconstructive advancement with SSG (n = 7) (40%), pedicled ALT (n = 4)
techniques were included in the study. Patients with (22%), gracilis muscle flap with SSG (n = 4) (22%), and
uncontrolled diabetes were excluded from the medial thigh flap (n = 3) (16.5%). The patients were
study. Demographics, etiology, reconstructive technique, followed on a regular basis with the mean of 8.7
complications, and patient satisfaction were identified. months [Table 1].

Patients with Fournier’s gangrene were initially treated by Local flap advancement in combination with SSG was
debridement, drainage, and antibiotics. The penoscrotal performed in 7 cases (5 cases following Fournier’s
defects were treated with local flap advancement with gangrene, 1 case following trauma, and 1 case
skin grafting, pedicled anterolateral thigh (ALT) flap, following burn injury). ALT flap was performed in 4
gracilis muscle flap with skin grafting, and medial thigh cases (3 cases following Fournier’s gangrene and 1 case
flap. Local flaps from remaining scrotal skin and adjacent following trauma). Gracilis muscle flap in combination with
medial thigh were advanced to cover the exposed SSG was performed in 4 patients (2 cases following
testes. Any remaining defect was skin grafted. Lateral Fournier’s gangrene, 1 case following trauma, and 1 case
thigh flaps were raised based on the lateral circumflex following burn patient). See Table 1 for a summary
femoral artery branch of the femoral artery to cover the of the patient included in the study. Medial thigh flap
defect [Figure 1a and b]. The donor area was primarily was performed in 3 patients (2 cases following Fournier’s
closed [Figure 1c and d]. Medial thigh flaps based on the gangrene and 1 case following trauma).
medial circumflex femoral artery branch of the femoral
artery was raised in the relatively bloodless subfascial A total of 6 patients developed complications. Three
plane. Gracilis muscle was separated from the distal patients developed a postoperative wound infection and
three developed wound dehiscence. Wound infection was
present in 3 of the Fournier’s gangrene cases, 2 of
which underwent local flap advancement in combination
with SSG, and 1 case underwent with ALT flap. Wound
dehiscence was present in 1 case of Fournier’s gangrene
operated with local flap advancement and SSG, in 1
case of trauma operated with local flap advancement
with SSG, and in 1 case of burn operated with gracilis
muscle flap with SSG. Pedicled thigh and medial thigh
flaps were associated with no complications.

Results were highly satisfactory in 6 patients, satisfactory in
8 patients, and not satisfactory in 4 patients. In patients
with local flap advancement with SSG, 4 patients were
satisfied, and 3 patients were not satisfied. In patients
with ALT flap, 3 cases were satisfied, and 1 case was
not satisfied. In patients operated with gracilis muscle flap,
Figure 1: (a) A 28-year-old male with a history of road traffic accident 3 cases were highly satisfied, and 1 case was satisfied.
presented with a penoscrotal soft tissue defect and exposed testes; In patients with medial thigh flap, 2 cases were highly
(b) raised anterolateral thigh flap; (c) the bridging segment was satisfied, and 1 case was satisfied. Scarring at the donor
de-epithelized, and the flap was tunneled; the defect was covered,
and the donor area was primarily closed; (d) 10 days postoperative result site was limited and acceptable. Patient compliance with
Plast Aesthet Res || Vol 3 || Issue 2 || Feb 29, 2016 65