Wei Peng, Zheng Junshui, Wu Yibing, Chen Linhai, Wang Yangjian, Yang Fan, Xu Youjia
Department of Othopaedics, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China;Department of Plastic and Reconstructive Surgery, Ningbo First Hospital, Ningbo Zhejiang, 315000, P.R.China.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Oct 15;34(10):1288-1293. doi: 10.7507/1002-1892.202003154.
To explore the suitable division of male genitalia subunits and the effectiveness of large-area perineum defect repair under its guidance.
According to the anatomical and functional characteristics of male genitalia, the subunit division scheme was proposed: area Ⅰ, glans penis; area Ⅱ, body of penis; area Ⅲ, scrotum; area Ⅳ, scrotum. Between April 2017 and July 2019, 12 patients with large genitalia defects were treated, with an average age of 60.9 years (range, 57-66 years) and an average disease duration of 2.7 years (range, 2-5 years). The defect area involved area Ⅰ in 1 case, area Ⅱ in 7 cases, area Ⅲ in 5 cases, and area Ⅳ in 8 cases; the size of area ranged from 6 cm×4 cm to 23 cm×16 cm. The causes of defect included 3 cases of trauma, 6 cases of Paget disease, 2 cases of squamous cell carcinoma, 1 case of spindle cell tumor. According to the design of the corresponding repair scheme, the main repair methods were to rotate and advance the skin flap and pedicled skin flap in the same area. When the defect was large, the free skin flap transplantation, free skin grafting, and free mucosa transplantation were used to repair the defect.
All the patients were followed up 6-13 months with an average of 8.6 months. Skin flap, skin graft, and mucosa survived in one stage in 10 patients; infection occurred in 1 case after the scrotal flap of area Ⅲ was transferred to repair the defect in area Ⅱ, 1 case had distal venous crisis at 2 days after repair area Ⅲ defect used free anterolateral thigh flap, and after active treatment, the condition improved. The appearance of the receiving area and the supplying area was good, and the local feeling was recovered satisfactorily. The range of motion of hip joint was good in 10 cases, and 2 cases were slightly stretched but did not affect normal life. All patients had normal urination and defecation function, and were satisfied with the treatment effectiveness.
The subunits of male genitalia can be used to guide the repair of the defect, which can better restore the physiological appearance and function, and has positive clinical significance.
探讨男性生殖器亚单位的合适划分方法及其指导下大面积会阴缺损修复的效果。
根据男性生殖器的解剖和功能特点，提出亚单位划分方案：Ⅰ区，阴茎头；Ⅱ区，阴茎体；Ⅲ区，阴囊；Ⅳ区，会阴部。2017年4月至2019年7月，治疗12例男性生殖器大面积缺损患者，平均年龄60.9岁（范围57 - 66岁），平均病程2.7年（范围2 - 5年）。缺损区域累及Ⅰ区1例，Ⅱ区7例，Ⅲ区5例，Ⅳ区8例；面积大小为6 cm×4 cm至23 cm×16 cm。缺损原因包括外伤3例，佩吉特病6例，鳞状细胞癌2例，梭形细胞瘤1例。根据相应修复方案设计，主要修复方法为同一区域皮瓣旋转推进及带蒂皮瓣修复。缺损较大时，采用游离皮瓣移植、游离皮片移植及游离黏膜移植修复缺损。
所有患者随访6 - 13个月，平均8.6个月。10例患者皮瓣、皮片及黏膜一期成活；Ⅲ区阴囊皮瓣转移修复Ⅱ区缺损后1例发生感染，Ⅲ区缺损采用游离股前外侧皮瓣修复术后2天1例出现远端静脉危象，经积极治疗后病情好转。受区与供区外观良好，局部感觉恢复满意。10例患者髋关节活动范围良好，2例略有受限但不影响正常生活。所有患者排尿及排便功能正常，对治疗效果满意。
男性生殖器亚单位可用于指导缺损修复，能更好地恢复生理外观及功能，具有积极的临床意义。
