Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC.
Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC.
Urology. 2021 Jun;152:196. doi: 10.1016/j.urology.2021.02.007. Epub 2021 Feb 11.
To demonstrate a technique for performing orchidopexy and split-thickness skin graft for patients with deficient scrotal skin after debridement for Fournier's gangrene. This is an alternative strategy to healing by secondary intention, flaps, or testicular thigh pouches.
Orchidopexy was performed after initial debridement using interrupted Vicryl sutures to bring the testicles and inferior penis together. During this procedure, the testicles and spermatic cord were mobilized, and redundant spermatic cord was coiled under the abdominal wall. Once patients were medically stable with no additional planned debridement, a split-thickness skin graft at a depth of 18/1000 inch and meshed 2:1 was applied to the scrotum. The graft was covered with a bolster dressing that was sutured to the scrotum for 5 to 7 days. An inpatient stay was not required after skin graft and bolster placement. Patients were evaluated for cosmetic appearance, pain, and need for revision.
From 2017-2021, 10 patients underwent orchiopexy and split-thickness skin graft to the scrotum. Etiology of Fournier's gangrene included diabetes (5), urethral stricture (2), alcohol abuse (2), unknown (1). Median age was 56 years and median BMI was 30 kg/m. Median length of stay after orchidopexy and skin graft were 18 and 9 days respectively. At a median follow-up of 8 months, there were no issues with chronic pain, discomfort, or need for further intervention.
Orchidopexy and split-thickness skin graft to scrotum is a feasible method of scrotal reconstruction that leads to acceptable clinical and cosmetic results, and does not result in prolonged inpatient hospitalization. Future research should focus on long term sexual function and quality of life outcomes.
展示一种在清创治疗 Fournier 坏疽后阴囊皮肤缺损的患者中进行睾丸固定术和断层皮片移植的技术。这是一种替代二期愈合、皮瓣或睾丸大腿袋的策略。
在初次清创后，使用间断的 Vicryl 缝线进行睾丸固定术，将睾丸和阴茎下部一起拉近。在这个过程中，睾丸和精索被移动，多余的精索被盘绕在腹壁下。一旦患者病情稳定，没有其他计划的清创，就可以在阴囊上应用 18/1000 英寸深度和 2:1 网孔的断层皮片。移植皮片覆盖压舌板敷料，用缝线固定在阴囊上 5-7 天。在放置皮肤移植和压舌板后，不需要住院。对患者的美容外观、疼痛和是否需要修复进行评估。
从 2017 年至 2021 年，有 10 名患者接受了睾丸固定术和阴囊断层皮片移植。Fournier 坏疽的病因包括糖尿病（5 例）、尿道狭窄（2 例）、酒精滥用（2 例）、原因不明（1 例）。患者的中位年龄为 56 岁，BMI 中位数为 30kg/m。睾丸固定术和皮片移植后的中位住院时间分别为 18 天和 9 天。在中位随访 8 个月时，没有出现慢性疼痛、不适或需要进一步干预的问题。
睾丸固定术和阴囊断层皮片移植是一种可行的阴囊重建方法，可获得可接受的临床和美容效果，且不会导致住院时间延长。未来的研究应侧重于长期性功能和生活质量的结果。
