Use of the Scrotal Remnant as a Tissue-Expanding Musculocutaneous Flap for Scrotal Reconstruction in Pagetʼs Disease

Abstract

Wide excision of extramammary Paget's disease of the penoscrotal region may leave large defects that cannot be closed easily. The authors describe their experience with a series of 6 patients in whom reconstruction of the scrotal defect was undertaken using the scrotal remnant raised as a stretchable musculocutaneous flap. It was observed that as little as a third of the residual scrotum could be expanded to resurface the entire scrotum. All flaps survived completely. Severe scrotal edema and ecchymosis were observed in 1 patient but the symptoms resolved completely with Trendelenburg positioning. The penile defects were resurfaced individually with thick skin grafts. Good-quality take with no chordee was observed in all patients after initial reconstruction. One patient developed penile contracture after reexcision of recurrent disease. Mean follow-up was 22 months (range, 3-60 months). Large defects of as much as two thirds of the scrotum may be reconstructed successfully using the tissue-expanding scrotal musculocutaneous flap.

Reconstruction of soft tissue defects in Fournier's gangrene at a tertiary care centre

“…As little as one-third of residual scrotum can be stretched to resurface the entire scrotum. 13 Excessive undermining and suturing under tension, however, may lead to flap loss or wound edge necrosis. 3 This flap is technically easy with less donor site morbidity and other complications.…”

Penoscrotal extramammary Paget's disease: surgical techniques and follow-up experiences with thirty patients

“…The primary treatment is surgical excision. 7,9,11,[14][15][16][17] Non-surgical methods are also used but only in a few cases. Hata reported that radiotherapy was a curative therapy in 22 patients with EMPD.…”

Evaluation of scrotal reconstruction with thigh flap

“…The common methods are skin grafting, burying them underneath the medial thigh skin, tissue expansion of adjacent tissues and use of local fasio-cutaneous or musculo-cutaneous flaps. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Local pedicled fascio-cutaneous flaps from the thigh and the groin area offer the advantages of avoiding skin graft problems, preserving adequate sensation, and covering a large defect.…”