Gudaviciene Daiva, Milonas Daimantas
Department of Surgery, Vilnius University Hospital of Oncology, Vilnius, Lithuania.
Urol Int. 2008;81(1):122-4. doi: 10.1159/000137654. Epub 2008 Jul 16.
Major scrotal and penile skin loss is uncommon and management of such an injury is a challenging problem for genitourinary reconstruction surgeons. Less than 50% scrotal skin loss can often be closed without difficulties immediately after trauma with surrounding tissue. In cases of more significant skin loss, the testes may be preserved by placing them in thigh pouches or dressed with wet dressings until reconstruction, or split thickness skin grafting can be performed. The surgeon's decision depends on the cause of skin loss - trauma, Fournier's gangrene or others. We describe a case of massive scrotal and penile skin loss due to an incident with an agricultural machine. The scrotal reconstruction, performed in three steps, was chosen because of its simplicity, early closure of the wound, excellent cosmetic appearance and maintenance of sexual functions. In the first step the penis was covered with remnant scrotal and preputium skin, and the testes were placed in thigh pouches. Incision of thigh flaps was planned to perform the second step and finally scrotal reconstruction with thigh pedicle flaps was done. Results were satisfactory from an esthetical and functional point of view.
阴囊和阴茎皮肤大面积缺损并不常见，对于泌尿生殖重建外科医生来说，处理这种损伤是一个具有挑战性的问题。创伤后，不到50%的阴囊皮肤缺损通常可立即用周围组织顺利闭合。在皮肤缺损更严重的情况下，可将睾丸置于大腿袋中或用湿敷料覆盖直至重建，也可进行中厚皮片移植。外科医生的决定取决于皮肤缺损的原因——创伤、福尼尔坏疽或其他原因。我们描述了一例因农业机械事故导致阴囊和阴茎皮肤大面积缺损的病例。由于其操作简单、伤口能早期闭合、美容效果极佳且能维持性功能，因此选择分三步进行阴囊重建。第一步，用残留的阴囊和包皮皮肤覆盖阴茎，并将睾丸置于大腿袋中。计划切开大腿皮瓣进行第二步，最后用带蒂大腿皮瓣进行阴囊重建。从美学和功能角度来看，结果令人满意。
