Use of bilateral pedicled scrotal flaps to restore penile shaft defects: technic and results
Mendel, L1; Morel Journel, N2; Allepot, K2; Paparel, P2; Ruffion, A2; Terrier, JE2
1: University Hospital of Nice, France; 2: University Hospital of Lyon, France
Objective: Penile shaft defects from all causes represent an uncommon pathological state with non-negligectable physiological and psychological impacts. Their treatment must meet functional and cosmetic expectations, and most often includes the use of skin graft, with suboptimal outcomes. Our aim was to describe the procedure and outcomes of the use of bilateral pedicled scrotal flaps that could become an interesting alternative to skin graft.
Material and Methods: All patients who underwent a penile plasty by bilateral scrotal flaps in our centre between 2009 and 2016 have been included. We collected in patients’ files demographic data, comorbidities, causes of penile shaft defect, perioperative data and surgical complications. The procedure [Figure 1] consists in harvesting bilateral scrotal flaps, pedicled on superficial external iliac vessels, including the Dartos fascia, which are dissected and separated from the tunica vaginalis and then rotated along the penis, close to the Buck fascia. Flaps are then sutured to the coronal sulcus mucosa and lengthwise to each other on the ventral and dorsal sides of the penis.
Results: Twenty-two patients were included with a median follow-up of 10.5 months. Causes of shaft defects were iatrogenic, concealed penis, tumors, dermatosis or subcutaneous injections of foreign materials. Mean operating time was 150.3 minutes and mean hospitalization time was 4.6 days. Early complications were suture dehiscence (36.4%), infection (13.6%) and hematoma (9.1%), with 9.1% of surgical revisions. Late complications were testicular ascension (27.3%), skin retraction (31.8%), pyramidal shape (9.1%) or shortening (13.6%) of the penis, with a total of 27.3% of surgical revisions [Table 1].
Conclusion: In our experience, penile plasty by bilateral pedicled scrotal flaps rotation seems to be a simple, safe and efficient procedure for shaft defects reconstruction. That underused technic could challenge skin graft, still widely used in this indication.
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