Vantomme M, Viard R, Aimard R, Vincent P-L, Comparin J-P, Voulliaume D
Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier Saint-Joseph Saint-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier Saint-Joseph Saint-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
Ann Chir Plast Esthet. 2019 Feb;64(1):78-85. doi: 10.1016/j.anplas.2018.03.005. Epub 2018 Apr 11.
The ischiatric pressure sore is a common pathology in rehabilitated spinal cord injured people, despite careful prevention. Medical treatment by discharge and directed healing is not always sufficient and surgery using local musculocutaneous flaps is often essential. Unfortunately, recidivism is frequent and the availability of local flaps is limited. The scrotal flap is an excellent complement to classic flaps, gluteal flaps or hamstrings. It can be used alone or in addition to another musculocutaneous flap, in first or second intention.
The scrotal flap is a musculocutaneous flap, using the Dartos, the platys muscle of the scrotum. It is richly vascularized, extensible and resistant. Its great plasticity makes it adaptable to any form of loss of substance, with an arc of rotation that can reach the anal margin. It can also be desepidermized and buried to fill a deep defect. Ten cases of scrotal flaps and their different indications are reviewed: some are used in first intention, others in addition to musculocutaneous flaps.
The removal of a scrotal flap is fast and extremely easy. The simple closure of the donor site allows the sampling of half of the scrotum due to the great local laxity. The scrotal flaps achieved quickly healed, as well as the donor sites. Only one recurrence was observed after an inappropriate treatment of underlying osteitis. No complications have occurred.
The scrotal musculocutaneous flap, reliable, resistant, quick and easy to remove is an excellent means of coverage of the perineal region. It can be used for the treatment of any loss of perineal substance in humans, but remains particularly useful for the treatment of ischial or perineal pressure sores.
