Reconstruction of a Scrotum by Combining Two Skin Flaps in a Ball Shape.

Background: The scrotum functions to maintain spermatogenesis and hormonal production of Leydig cells by preventing the testicles from rising in temperature and protecting them from the outside world. The scrotum, along with the penis, is also an organ that symbolizes masculinity. Therefore, deformity or loss of the scrotum can be a major psychological problem. Various scrotal reconstruction techniques have been reported. In these papers, there is some discussion about the type of skin flap, but little discussion about the method of suturing the skin flap. We devised a way to reconstruct a scrotum to a natural size by suturing two skin flaps together to form a ball shape. Case Presentation. Case 1 was a patient with a missing scrotum due to Fournier's gangrene. Total resection of the scrotum, including the bilateral testes, was performed to save his life. Reconstructive surgery was performed 11 days after the initial surgery. Reconstruction was performed using bilateral gluteal fold flaps. Case 2 was a patient with a congenital defect of the scrotum. The testis on the right side exhibited cryptorchidism, and the scrotum was missing, and the testis on the left side was encased in a hypoplastic scrotum. Reconstruction was performed using an internal pudendal artery perforator flap. Conclusion: There are two types of scrotal defects: those with testes present and those with testes missing. This method can be used for both types of scrotal defects, and we were able to create a scrotum that satisfied each patient.

Scarring Caused by the Percutaneous Approach to Fractures of the Orbit and Orbital Rim.

ABSTRACT: Percutaneous and transconjunctival approaches are commonly used for fractures of the orbit and orbital rim. However, it leaves visible scarring on the face. Although previous studies reported scarring from the percutaneous approach, few reported the degree of such scarring. The authors examined the degree of scarring associated with percutaneous approaches to fractures of the orbit and orbital rim in the Japanese population. The authors reviewed photographs of patients who were treated surgically for fractures of the orbital floor, medial orbital wall, or zygomatic bone via percutaneous approaches to examine the presence of scarring and deformation. In 36% of all patients, the observers were unable to determine the side on which the surgery was performed. Furthermore, the site of scarring was identified accurately in only 20.6% of the cases in which observers were able to identify the surgical side. The authors' study demonstrated that the subciliary approach left minimal scarring under the eyelashes. On the other hand, the medial canthal approach left depressed and wide scarring, whereas pigmentation was apparent in patients who underwent surgery via the lateral eyebrow approach. Similarly, pigmentation under the eyelashes and at the site of secondary incision was common after the subciliary approach.

Distal nail embedding treatment using autogenous nails.

A regrowing nail tip after nail avulsion may excessively curve and invaginate into the nail bed. This is treated as a type of ingrown toenail, and is known as distal nail embedding. In most cases, further growth restores the original shape evenly over the nail bed. However, it is often painful and such cases may require treatment. We report a surgical approach that we applied to six cases of distal nail embedding involving pain or deformity of nails caused by a nail tip invaginating into the nail bed and/or cessation of forward nail growth. As our method involves removing a portion of the embedded tip edge nail and inserting the removed nail into the remaining depressed portion, the nail can grow over the bulge. In all six patients in whom we applied this method, the pain and nail deformity resolved and there was no recurrence. We used autogenous nails, which can reduce the pressure imbalance on a nail bed, and this contributed to improving the morphology of nails and nail beds. In addition, the risk of a hypertrophied nail is reduced because half of the nail adheres to the nail bed. Special materials are unnecessary and this method can be conducted with simple outpatient department procedures. There were no cases of a fixed nail section detaching due to a bulge at the nail tip. The inserted nail was maintained in all cases for several months until the nail grew over the bulge.