Management of genital skin loss.

Figure 12 is an algorithm outlining the methods of management. In most patients, partial skin loss can be managed by closure with remaining local skin. Tensive partial loss of penile skin may require grafting. Potent patients should have thick split-thickness grafts or full-thickness grafts. Impotent patients should have coverage with meshed split-thickness grafts or scrotal flaps when available. Partial scrotal loss is seldom a problem, as local flaps and closure of the defect with the remaining scrotal skin can usually be accomplished. After total scrotal loss, the testicles should be placed temporarily in thigh pouches. Later, a new scrotum can be created with meshed split-thickness grafts or thigh-based cutaneous flaps. Aggressive wound care, appropriate timing of reconstruction, and adherence to basic principles of reconstructive surgery will result in functional recovery and a cosmetically acceptable appearance.