Abstract
Background: Degloving penoscrotal injuries are uncommon events. Accidents with agricultural machine belts or industrial machines are its leading cause. Management of degloving injury can be either single stage or staged procedures depending on the severity. We report our experience in management of degloving penoscrotal injury with anteromedial testicular thigh pouch and skin graft.
Materials and Methods: In between July 2014 and June 2017, seven male patients presented to us with degloving penoscrotal injury and their data were recorded. Investigations included blood examinations, wound swab culture and sensitivity, ultrasonography and retrograde urethrogram. All were managed with anteromedial thigh testis burial and skin graft over the penile shaft. Treatment outcome was assessed in terms of cosmesis, voiding function, quality of life, and complications.
Results: At a mean follow-up of 25 months all had good quality of life. Their median age was 29.29 yrs (range 20-40 yrs). Industrial and agricultural machine injury was cause of degloving penoscrotal injury in 3 patients each and dog bite was seen in 1 patient. Anteromedial testicular thigh pouch and skin graft was performed in all patients. All complications were transient and managed conservatively. Normal voiding function and erection of penis were seen in all patients with satisfactory cosmetic result.
Conclusion: Anteromedial testicular thigh pouch with skin graft, as a single stage procedure is a good surgical option in the management of degloving penoscrotal injury.
Keywords: Degloving; Penoscrotal; Testicular; Thigh Pouch; Skin Graft.
References
1. Finical SJ, Arnold PG (1999) Care of the degloved penis and scrotum: a 25- year experience. Plast Reconstr Surg 104: 2074-2078.
2. S Sengathir Selvan, Ganesh S Alagu, R Gunasekaran : Use of a hypogastric flap and split-thickness skin grafting for a degloving injury of the penis and scrotum: A different approach.:Case report. Ind. J. Plast.Surg. 2009;42:258-60.
3. Ashok M.B., Prashant N.M., Manoj S. Fournier’s gangrene: review of 110 cases for etiology, predisposing conditions, microorganisms, and modalities for coverage of necrosed scrotum with bare testes. J. New Zealand.Med.Ass. 2008;121.
4. D'Alessio E., Rossi F. and D'Alessio R.: Reconstruction in traumatic avulsion of penile and scrotal skin. Ann. Plast. Surg., 1982;9:120-4.
5. Por Y., Tan B., Hong S., Chia S., Cheng C.W.S., Foo C. and Tan K.: Use of the Scrotal Remnant as a Tissue- and Tan K.: Use of the Scrotal Remnant as a Tissue- Expanding Musculocutaneous Flap for Scrotal Reconstruction in Paget's Disease. Ann. Plast. Surg., 2003;51:155-60.
6. Balakrishanan C.: Scrotal avulsion: A new technique of reconstruction by split skin graft. Br. J. Plast. Surg., 1958;9:38.
7. P. Schaller, Z. Akcetin, R.kuhn, C. Radu and J.Geldmacher. Scrotal reconstruction after Fournier's gangrene with simple skin grafting. Europ. J. Plast. Surg., 1994;17:261-63.
8. Zeng A., Xu J., Yan X., You L. and Yang H.: Pedicled Deep Inferior Epigastric Perforator Flap: An Alternative Method to Repair Groin and Scrotal Defects. Ann. Plast. Surg., 2006;57:285-88.
9. Kamei Y., Aoyama H., Yokoo K., et al.: Composite gastric Kamei Y., Aoyama H., Yokoo K., et al.: Composite gastric seromuscular and omental pedicle flap for urethral and scrotal reconstruction after Fournier’s gangrene. Ann. Plast. Surg., 1994;33: 565.
10. Young W.A. and Wright J.K.: Scrotal reconstruction with a rectus abdominis muscle flap. Br. J. Plast. Surg., 1988;41:190.
11. Westfall C.T. and Keller H.B.: Scrotal reconstruction utilizing bilateral Gracillis myocutaneos flaps. Plast. Reconstr. Surg., 1981;68: 945-47.
12. Ramos R.R., Andrews J.M. and Ferreira L.M.: A Gracillis myocutaneos flap for reconstruction of the scrotum. Br. J. Plast. Surg., 1984;37: 171.
13. Yu P., Sanger J.R., Matloub H.S., Gosain A. and Larson D.: Anterolateral Thigh Fasciocutaneous Island Flaps in Perinioscrotal Reconstruction. Plast. Recosntr. Surg., 2002;109: 610-16.
14. Di Geronimo E.M.: Scrotal reconstruction utilizing a unilateral adductor minimus myocutaneos flap. Plast. Reconstr. Surg., 1982;70:749.
15. Koshima I., Soeda S., Yamasaki M. and Kyou J.: The free and pedicled anteromedial thigh flap. Ann. Plast. Surg., 1988;21:480.
16. Hirshowitz B. and Peretz B.A.: Bilateral superomedial thigh flaps for primary reconstruction of scrotum and vulva. Ann. Plast. Surg., 1982;8:390-96.
17. Gencosmano AYlu R, Bilkay U, Alper M, Gurler T, Cagdaş A (1995) Late results of split-grafted penoscrotal avulsion injuries. J Trauma 39: 1201-1203.
18. Fu Q (2006) Repair of necrosis and defects of penile skin with autologous free skin flap. Asian J Androl 8: 741-744.
19. Kim K.S., Noh, B.K., Kim D.Y., Lee S.Y. and Cho B.H.: Thin Para umbilical PerforatorBased Cutaneous Island Flap for Scrotal Resurfacing. Plast. Reconstr. Surg., 2001;108: 447-51.
20. Wolach MD, MacDermott JP, Stone AR, et al. Treatment and complications of Fournier's gangrene. Br J Urol., 1989;64:310.
21. Tiwari I.N., Seth H.P. and Mehdiratta K.S.: Reconstruction of the scrotum by thigh flaps. Plast. Reconstr. Surg. 1980;66: 605-6.
22. Bruner,J.M. Traumatic avulsion of skin in male external genitalia. Plast. Reconstr. Surg1950;6: 334-38.
23. Zanettini LA, Fachinelli A, Fonseca GP (2005) Traumatic degloving lesion of penile and scrotal skin. Int Braz J Urol 31: 262-263.
24. Still EF 2nd, Goodman RC (1990) Total reconstruction of a two-compartment scrotum by tissue expansion. Plast Reconstr Surg 85: 805-807.
25. A Ward M, L Burgess P, H Williams D, E Herrforth C, L Bentz M, et al. (2010) Threatened fertility and gonadal function after a polytraumatic, life-threatening injury. J Emerg Trauma Shock 3: 199-203.
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.27
