Reconstruction Using Local Flaps for Penoscrotal Defects after Ablation of Skin Lesions

Abstract

Penoscrotal defects are associated with a variety of conditions, including extramammary Paget disease (EMPD), Fournier's gangrene (FG), and skin cancer. Careful reconstruction of the penoscrotal region is vital for sexual and urological functions [1]. The aims of reconstruction are to assist wound healing and provide adequate function and acceptable appearance. However, reconstruction of penoscrotal defects is difficult because of the variety of skin colors and thicknesses, the presence of bacterial flora, difficulty in immobilization, and complicated contours [1]. Therefore, a variety of approaches must be used for reconstruction, which are based on the size, position, and severity of the defect and the availability of surrounding tissue.We reconstructed penoscrotal defects using local advancement scrotal flaps, skin grafting, anterolateral thigh (ALT) flaps, and internal pudendal artery perforator (IPAP) flaps and obtained satisfactory results. The purpose of the study was to review and analyze the results of our patients who underwent reconstruction of penile and scrotal defects. AbstractBackground: Penoscrotal defects are associated with a variety of conditions, including extramammary Paget disease, Fournier's gangrene, and skin cancer. Careful reconstruction of the penoscrotal region is vital for sexual and urological functions. We used a variety of methods to reconstruct penoscrotal defects and obtained satisfactory results. Methods: We performed a retrospective chart review of 13 patients who underwent penoscrotal reconstruction from January 2012 to May 2016. All patients underwent radical debridement. The defect sizes ranged from 4 to 225 cm 2 (mean 75.0 cm 2 ). The reconstructive procedures were performed using split-thickness skin grafts (STSGs) and scrotal advancement, pedicled anterolateral thigh (ALT), and internal pudendal artery perforator (IPAP) flaps. Results: All of the flaps survived, with no reports of total flap necrosis or congestion. The overall surgical complication rate was 23.1%. A hematoma occurred in 1 patient and wound dehiscence occurred in 2 patients; the problems resolved after a minor surgical procedure. Conclusion: The selection of an appropriate reconstruction method should be based on the size, location, and severity of the defect in addition to the availability of local tissue. A skin graft is recommended for defects of the penile shaft. A scrotal flap is appropriate for the reconstruction of small scrotal defects, whereas the pedicled ALT flap and IPAP flap are recommended for large defects. We have proposed a flowchart for the reconstruction of penoscrotal defects that is based on the characteristics of the defects and our clinical experience.

Utility of Groin Flap in Penile Reconstruction

“…While in most cases, primary closure of the donor area is possible, for wider ALT flaps, a skin graft is required for closure of donor area. For these reasons the morbidity rates of the donor site are higher, and the ALT flap is generally not favored as a surgical method [4].…”

“…However, the location of the flap pedicle makes it difficult to reconstruct a penile shaft defect. In this case, other surgical techniques like skin grafting may be necessary to cover the penile shaft defect [4].…”

“…Multiple methods have been proposed to reconstruct penile defects of different origins, and each has its strengths and weaknesses. Skin graft reconstruction is the simplest, but it is not able to secure appropriate volumes and has the associated risk of shearing and contracture [4,5]. The scrotal flap technique is simple with fewer complications, but it is difficult to obtain appropriate bulkiness, and has cosmetic disadvantages after surgery arising from ectopic hair growth [6,7].…”

Management of peno-scrotal wound defects in a tertiary hospital in North-Western Nigeria: a 20-year retrospective review

“…Option of management depends on the location of the defect, size, and state of the surrounding skin [3]. Most of the scrotal defects are amenable to direct closure or healing by secondary intention if small (2-5 cm), while larger defects require advancement or rotational flaps [5,8].…”

“…Most of the scrotal defects are amenable to direct closure or healing by secondary intention if small (2-5 cm), while larger defects require advancement or rotational flaps [5,8]. Due to the inelastic nature of the penile skin, most of the penile defects away from the scrotum may be managed by skin graft and local flaps [3,5,10].…”