Tabatabaei Shahin, McDougal W Scott
Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
J Urol. 2003 Jan;169(1):118-20. doi: 10.1016/S0022-5347(05)64049-9.
PURPOSE Large groin defects may be created after inguinal lymphadenectomy for bulky metastatic penile cancer. We describe a new method of primary closure of a large groin skin defect. MATERIALS AND METHODS In 3 patients with large volume inguinal lymph node metastases with skin breakdown and secondary infection extensive inguinal lymphadenectomy was done with wide surgical excision of skin and subcutaneous tissue. The procedures resulted in a large groin defect. Sartorius muscle was transferred to cover the femoral vessels. An abdominal advancement cutaneous flap was placed for soft tissue and skin coverage of the wound. RESULTS Primary closure of a large skin defect was possible using an abdominal advancement flap. In all patients the wound healed primarily with good cosmesis. A single patient underwent postoperative external beam radiation therapy to the flap site with no untoward effect on graft survival. CONCLUSIONS Large groin skin defects can be closed primarily using an abdominal advancement flap. This technique may also be used for bilateral groin defects. Compared with other types of flaps advocated for this purpose the main advantages of the procedure are simplicity, lower morbidity and superior cosmetic results.
目的 对于体积较大的转移性阴茎癌患者，腹股沟淋巴结清扫术后可能会形成较大的腹股沟缺损。我们描述一种新的一期闭合腹股沟大面积皮肤缺损的方法。材料与方法 3例腹股沟淋巴结大量转移且伴有皮肤破溃和继发感染的患者，行广泛腹股沟淋巴结清扫术，同时广泛切除皮肤和皮下组织。手术导致腹股沟出现大的缺损。将缝匠肌转移以覆盖股血管。放置腹部推进皮瓣用于伤口的软组织和皮肤覆盖。结果 使用腹部推进皮瓣可一期闭合大面积皮肤缺损。所有患者伤口均一期愈合，美容效果良好。1例患者术后对皮瓣部位进行了体外照射放疗，对移植物存活无不良影响。结论 腹股沟大面积皮肤缺损可通过腹部推进皮瓣一期闭合。该技术也可用于双侧腹股沟缺损。与为此目的所倡导的其他类型皮瓣相比，该手术的主要优点是操作简单、发病率低和美容效果好。
