scrotal reconstruction
Scrotal reconstruction is required after extensive scrotal tissue loss due to various reasons.
- 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.
One stage reconstruction with somatically acceptable results.
Reconstruction depends on the size of defects.
- Defects up to 50% of scrotum can be closed primarily.
- More extensive defects requires 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 pedicled VRAM flap, a pedicled ALT flap, gracilis flap , or a sensate superomedial thigh fasciocutaneous flap may be considered.
Duration of surgery depends on the size and configuration of defect and the technique being used for reconstruction. It can be anywhere between 2-4 hours.
The operation is performed under general anaesthesia and usually requires overnight stay. The doctors may advise limited mobilization for a couple of days to allow graft to take.
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 cosmesis and need for further surgeries.
Generally, if the cause of tissue loss has been sorted and all non-viable tissue removed, the outcome of reconstruction are satisfactory and successful.
Skin graft reconstruction may remain insensate, and can also be reason of testicular torsion. Flap reconstruction may have cosmetically poor results
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