Scrotal reconstruction is required after extensive scrotal tissue loss due to various reasons

INDICATION

Loss of scrotal skin due to;

• Fournier’s gangrene/other severe infection
• Trauma (blunt, penetrating, burn)
• Lymphedema (congenital, acquired, infectious)
• Hidradenitis suppurativa (HS)
• Genital cancers

A thorough understanding of the defects is essential after initial and emergency management of these condition before starting reconstruction

GOALS

One stage reconstruction with somatically acceptable results

OPTIONS

Reconstruction depends on the size of defects. 

• Defects up to 50% of scrotum can be closed primarily.
• More extensive defects require skin grafts(meshed) or local skin flaps or tissue expansion techniques.
• For extensive wounds, testes can be temporarily placed in the medial thigh pouch until definitive reconstruction  or dressed frequently with wet dressings.
• For extremely large scrotal defects, local flaps such as a pedicle VRAM flap, a pedicle ALT flap, gracilize flap , or a sensate super medial thigh fasciocutaneous flap may be considered

FAQs

1. What is the duration of surgery?

Duration of surgery depends on the size and configuration of defects and the technique being used for reconstruction. It can be anywhere between 2-4 hours.

2. How long is the hospital stay?

The operation is performed under general anesthesia and usually requires overnight stay. The doctors may advise limited mobilization for a couple of days to allow graft to take.

3. What are the complications of surgery?

It depends on the technique of reconstruction and may include Infection, bleeding, loss of graft or flap(partial or complete), scarring, sensory disturbance, contour abnormalities, poor cosmoses and need for further surgeries.

4. What to expect as a surgery outcome?

Generally, if the cause of tissue loss has been sorted and all non-viable tissue removed, the outcome of reconstruction is satisfactory and successful.

5. What are the Long term effects?

Skin graft reconstruction may remain insensate, and can also be the reason for testicular torsion.

Flap reconstruction may have cosmetically poor results

 

Written by :  Dr. Sobia Yasmeen

Copyrights: Pakistan association of Plastic Surgeons