Bipedicled scrotal flaps combined with keystone-design perforator island flaps in repairing postoperative large-area defects in 6 male patients with extramammary Paget′s disease of the perineum / 中华皮肤科杂志

Objective:To evaluate clinical efficacy of bipedicled scrotal flaps combined with keystone-design perforator island flaps in repairing postoperative large-area defects in male patients with extramammary Paget′s disease of the perineum.Methods:Clinical data were collected from 6 male patients with extramammary Paget′s disease of the perineum in Dermatology Hospital of Jiangxi Province from February 2018 to March 2019, and analyzed retrospectively. These patients were aged from 70 to 84 years (median, 77.5 years) , skin lesions involved the mons pubis, penis and scrotum, and the area of postoperative skin defects varied from 18 to 133 cm 2 (median, 96 cm 2) in size. In all the patients, mons pubis defects after tumor resection were repaired with abdominal keystone-design perforator island flaps, and scrotal and penile defects were repaired with bipedicled scrotal flaps using the remaining scrotal tissues. These patients were followed up at 1 and 3 months after surgery and every 3 months thereafter. Results:All the 6 patients were followed up for 3 - 36 months, with an average of 10 months. All flaps survived with a good color and texture match, and favorable function and appearance were achieved in both the donor and recipient sites.Conclusions:The bipedicled scrotal flaps combined with keystone-design perforator island flaps can repair postoperative large-area defects in male patients with extramammary Paget′s disease of the perineum. Moreover, the operation is simple, and good blood supply can be achieved.

Surgical Techniques for Correction of Penile Paraffinoma

@#Background: Penile augmentation using injection of a foreign body into penile skin was mainly performed by non-medical personnel. Majority of these patients end up with complication of an abnormal mass formation known as penile paraffinoma. Methods: We described three different surgical techniques for correction of penile paraffinoma based on our single-centre experience. Informed consents were obtained from patients whose photographs were taken during the operation step. Results: In general, three patients had simple excision biopsy with primary suturing, four patients underwent single stage excision of circumferential granuloma with bilateral scrotal skin flap reconstruction and one patient experienced dual stage procedure. Three of them were injected with paraffin, one with silicone and the remaining four were unable to identify the substance used. All patients successfully underwent the surgical procedure and four of them had minor postoperative surgical site infection and wound gapping. Conclusion: All patients recovered well and the mean International Index of Erectile Function (IIEF-5) score obtained was 24.25. In our experience, excision biopsy was adequate for focal mass and reconstructive surgery using bilateral scrotal flap was suitable for circumferential mass.

Application of oral mucosa graft transplant in the treatment of anterior urethral stricture / 中华整形外科杂志

Objective@#To evaluate the feasibility of buccal musoca grafting in the treatment of longer anterior urethral stricture.@*Methods@#From January 2012 to December 2017, 42 cases of anterior urethral stricture were treated in staged procedure. Stage 1 included the excision of the narrow urethra and the reconstruction of the urethra by transplanting buccal mucosa sheet or tube. In Stage 2, patients underwent operation including urethra anastomosis and transfer the scrotal flap for coverage, and perform suprapubic puncture cystostomy at the same time.@*Results@#Thirty-eight of 42 cases were followed up for 5-12 months with an average of 8 months. In the followed-up 38 cases, 35 of them obtained satisfactory result. Complications occurred in 2 patients, all of them suffered from urethra restricture. One patient′s urethra stricture was located in the anastomosis, stricture length was 0.5 cm. This patient received excision of the narrow urethra and anastomosis. Stricture in another patient was located in the external urethral meatus, this patient received expansion of the external urethral meatus. With proper treatment, all of them were recovered. One patient was not satisfied with the appearence of penis postoperatively. Of all these patients, no urethral fistula or penile curvature was observed. Urination and ejaculation were normal.@*Conclusions@#A successful treatment of long anterior urethral stricture can be achieved with the excision of affected urethra, reconstruction of defect urethra with buccal mucosa flap in staged procedure, and covering the new urethra by transferring the scrotal flap.

Perineum-based Pediculated Scrotal Flap for Reconstructive Urethral Surgery / 대한배뇨장애요실금학회지

Herein, we describe a perineum-based pediculated scrotal flap procedure for urethral reconstruction. A scrotal tubular flap was used as a substitute to correct a proximal penile urethral stricture in case 1. In case 2, a scrotal island patch was performed to treat an iatrogenic penile urethral injury. In both cases, the urethral catheter was removed on postoperative day 14 with simultaneous normal voiding cystourethrography. The excellent axial vascularization of this perineum-based pediculated scrotal flap procedure allows successful urethral reconstruction, regardless of extension, location, and etiology.

Treatment of Lymphedema of the Scrotum and Penis Using Scrotal Flaps

PURPOSE: Lymphedema of the scrotum and penis is a functionally and emotionally incapacitating problem for patients. Patients suffer pain from swelling, chronic irritation, repeated infections, drainage, and sexual dysfunction. Although there are various methods for the treatment of scrotal and penial lymphedema, achieving a satisfactory reconstruction in severe cases still remains a challenge due to the lack of locally available tissue. METHODS: A 33-year-old man sustained severe lymphedema of the scrotum and penis. He reported a history of swelling since 25 years, which had been intensified during the past few months. There was no history of irritation, surgery, trauma, infection or travel to endemic countries. The authors reconstructed the scrotum and penis using 4 scrotal flaps made by incising the enlarged scrotum crucially. RESULTS: The postoperative course was uneventful. Histopathologic examination showed nonspecific chronic inflammation. The patient was followed up for 18 months and a good reconstructive result was obtained with no recurrence. CONCLUSION: The authors' method is safe and easy to perform. This method may be a convenient and reliable alternative for the treatment of severe lymphedema of the scrotum and penis.

Resurfacing the Large Penoscrotal Defects with Various Local Flaps after Ablation of Extramammary Paget's Disease

PURPOSE: Penoscrotal extramammary Paget's disease is a rare cutaneous malignancy that primarily affects the elderly. To prevent local recurrence, adequate surgical excision with its intraoperative frozen section, proper reconstruction, and careful follow-ups are required. The present study describes the treatment of patients with penoscrotal extramammary Paget's disease, focusing on the reconstruction after the ablation of lesion. METHODS: Nine patients were selected who had undergone a local pedicle flap procedure due to the large defects after ablation of extramammary Paget's disease of the penoscrotal area, during the period of 1999 to 2005. Wide excision combined with intraoperative frozen sectioning was performed, and the penoscrotal wound was reconstructed with a local skin flap. Three flaps were chosen depending on the size of the defect. If the defect size was small and the scrotal tissue was adequate, scrotal flap(n=5) was enough for its reconstruction. However, as there were large defects with insufficient remnant scrotal tissue, a groin flap(n=2) or an anterolateral thigh flap(n=2) were performed. RESULTS: There were no complications with the postoperative wound. Furthermore, no local recurrence was noted during two to six years of follow-up period (mean average 3.7 years). CONCLUSION: For the resurfacing the penoscrotum at large defects after ablation of extramammary Paget's disease, we performed reconstruction with a local flap. In the aspect of both function and cosmetic concerns, the results were satisfactory.

The Treatment of Penile Paraffinoma Using Various Scrotal Flap

Paraffin injection for augmentation of penis is usually attempted by untrained persons. Complications such as penile deformity, skin necrosis, erectile dysfunction, and foreign body sensation usually follow. Definite treatment for the patients with those complications includes complete removal of skin and subcutaneous tissue infiltrated by the paraffin and resurfacing with skin graft and local flap. It may not be possible to remove paraffinoma completely due to infiltrated corpus cavernosum and spongiosum. The remnant paraffinoma does not permit skin graft coverage. For the patients who had these problems, we tried techniques comprised of various scrotal flaps to produce reliable and stable coverage. The scrotal skin, which has high elasticity and good texture, seems to be a good material for denuded penis coverage, despite its hairy nature. Since March 1998, 21 patients with penile paraffinoma have been treated using the various scrotal flaps. All flaps survived and the reconstructed penis had immediate postoperative tactile sensibility. The results were successful with no other major complications.

Penile Resurfacing after Removal of Penile Foreign Body Granuloma

The loss of penile skin, either traumatic or iatrogenic, is sometimes difficult to treat. Especially, treatment of the penile foreign body granuloma is very difficult. Surgical treatment of penile skin defect are a skin graft, flap-to-graft conversion method, and various scrotal flap. But these have many problems such as wound disruption, skin necrosis, skin contracture, and hypertrophic scar. We present our technique for penile resurfacing using apronlike scrotal flap and groin flap. Apron-like scrotal flap has several advantages: one stage operation, short operation time, avoidance of dorsal scar and flap necrosis, maintenance of erectile capacity. Also we think that groin flap is a proper method for the patients who suffer from a large penile skin defect and whose scrotal skin is not available. We did the research in patients with the penile foreign body granuloma who were used the techniques of groin flap and apron like scrotal flap in the operation from March 2000 to February 2002. All the 15 cases showed excellent outcome. Especially, apron like scrotal flap was very beneficial in patients whose scrotal skin was available.

Scrotal flap penoplasty of the paraffinomas penis: 15 years of experience.

A two-stage scrotal flap penoplasty was carried out on a paraffinomas penis. In the first stage, total excision of the penile paraffin-containing skin was performed; The denuded penis was embeded in the subcutaneous tunnel of the scrotal sac. A scrotal skin flap for covering the penile shaft was separated after four months. During the past 15 years, a study was undertaken on 174 patients with an average age of 44 years (figure I). A satisfactory result was found in 148 patients, with 26 cases having required minor corrective surgery (table 1). Satisfactory sexual function was found in 168 patients, mildly painful intercourse in four patients and impotency in two cases (table 2). The post operative complications (table 3) were mild graft infection in 32 patients, partial graft necrosis in 11 cases redundant penile skin in 16 cases and tortious shape of the scrotum in 15 cases. All the patients presented to the hospital, complaining of abnormal penile shape and unsuccessful sexual intercourse.

Extensive Penis Paraffinoma: Treatment by Penoplasty Using Various Scrotal Flaps and Radial Forearm Free Flap / 대한남성과학회지

PURPOSE: There is no single method of choice for penoplasty in extensive penile paraffinoma, and surgeons must choose a suitable method according to the condition of each individual patient. Herein, we present 19 cases of extensive penile paraffinoma treated with various scrotal flaps or a new method involving a radial forearm free flap. PATIENTS AND METHODS: We reviewed the 19 cases of penile paraffinoma, which affected the whole penile skin with or without involvement of the scrotal flap 5 cases, an "apron" scrotal flap in 4 cases, and a bipedicle scrotal flap in 3 cases. Because of his underdeveloped scrotum, a new technique, radial forearm free-flap penoplasty, was done in one patient with Klinefelter's syndrome. The postoperative results were satisfactory in all except six cases. One of these was managed by a secondary full-thickness skin graft for partial scrotal flap necrosis, and the others were managed by secondary simple repair for wound disruption and infection. All patients were satisfied with the cosmetic and functional results of the scrotal flap. CONCLUSIONS: Because of their great elasticity, scrotal flaps are extremely advantageous for the repair of an extensively denuded penis. A radial forearm free flap, perhaps including the subcutaneous tissue, a long vascular pedicle, and less hair, is an alternative method when a scrotal flap is not available. Its biggest drawback is the unpleasant appearance of the donor site, which is closed with a split-thickness skin graft.

Penile paraffinoma: 39 cases / 대한비뇨기과학회지

Penile paraffinoma chiefly resulting from injudicious paraffin injection into the penile tissue for the purpose or enlarging the penis and facilitating erection provokes a lot of serious undesirable effects. The only successful therapy for the complicated penile paraffinoma is adequate surgical excision of the involved tissue and repair of the denuded penis. But it is not easy to resurface the completely denuded penis after complete removal of extensive paraffinoma. Herein we present 39 eases of penile paraffinoma who underwent the surgical correction. The extent of paraffinoma was confined within the distal penile skin in 13 cases and spread to the whole penile skin with or without involvement of scrotum and prepubic soft tissue in 26 cases. The treatment modalities for covering the denuded penis after complete excision of the granulomatous tissue were bilateral pedicle scrotal flap in 23 cases. primary closure in 15 cases and Cecil`s scrotal implantation in 1 case. Bilateral pedicle scrotal flaps based on the lateral scrotal blood supply were extremely advantageous for repair of a extensively denuded penis because of their great elasticity and the cosmetic and functional results of the scrotal flap were satisfactory in all patients.