Penoscrotal defect: a functional, esthetic, and psychological challenge

Abstract

Aim: Penoscrotal defects may be caused by a variety of events. Reconstruction of the penoscrotal region is required not only for aesthetic appearance but also for functional and psychological reasons. Numerous techniques have been described for penoscrotal reconstruction reflecting the challenge and complexity of the region involved. This suggests that no single method is satisfactory for all types and degrees of tissue defects. This prospective study was conducted in a tertiary care hospital in India, over a period of 5 years.

Methods: Eighteen patients with penoscrotal defects of varying etiology were included in the study and underwent different surgical techniques. Age of the patients ranged from 20 to 60 years. The etiology of penoscrotal defect was Fournier’s gangrene in 12 cases, trauma in 4 cases, and burn in 2 cases. The patients with Fournier’s gangrene were initially treated by debridement, drainage, and antibiotics. The penoscrotal defects were treated with local flap advancement with skin grafting (n = 7), pedicled anterolateral thigh flap (n = 4), gracilis muscle flap with split skin grafting (n = 4), and medial thigh flap (n = 3).

Results: There was complete healing in 16 patients with minor complications in the form of partial skin graft loss (n = 1) and wound dehiscence (n = 1). Results were highly satisfactory in 6 patients, satisfactory in 8 patients, and not satisfactory in 4 patients. Scarring at the donor site was limited and acceptable.

Conclusion: The vast arsenal of options for penoscrotal defect coverage ranges from skin grafting to flaps, and every case needs a customized approach with regard to its feasibility, outcome, and complication rate. Flaps should be the preferred choice over the skin grafts because of the superior functional and aesthetic results and better compliance.

Keywords

Anterolateral thigh flap / gracilis muscle flap / penoscrotal defect

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