Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Urology. 2023 Dec;182:231-238. doi: 10.1016/j.urology.2023.07.039. Epub 2023 Sep 13.
To describe the surgical technique and evaluate the safety, feasibility, and preliminary outcomes of perineal closure with fasciocutaneous flaps as an alternative to scrotoplasty for large genital wounds.
Cases of perineal closure with fasciocutaneous flaps and thigh pouch creation for patients having undergone scrotectomy from January 2015 until August 2022 were reviewed for operative details and surgical outcomes.
Twenty patients were identified undergoing this procedure. Patients had a median age of 64 (Inter-quartile range [IQR] 58-70), body mass index of 34 (IQR 29-40) and Charlson comorbidity index of 5 (IQR 4-8). Median total wound area was 443 cm (IQR 225-600). Operative technique in all cases included testicular thigh pouch and fasciocutaneous flap creation for perineal closure; these flaps were raised from the thigh in 18 patients and abdominal wall in 8. This technique resulted in 100% closure rate of the perineum with 3 patients required abdominal split thickness skin grafting (STSG) to complete closure. Complication occurred in 3 patients (15%) with 1 wound infection and 2 episodes of bleeding. Forty percent of patients were discharged home. Median follow-up was 9 months with only 1 patient reporting pain related to thigh pouches and none desiring elective scrotoplasty.
Despite large defects, perineal closure was completed in all patients with minimal use of STSG. Complication rates were comparable to other methods despite significant patient frailty and no patients desired staged scrotoplasty. This method of closure adds an option for the complex perineal reconstruction patient.
描述会阴缝合的手术技术，并评估筋膜皮瓣在会阴重建中的安全性、可行性和初步结果，以替代用于治疗大的生殖器创伤的阴囊成形术。
回顾性分析 2015 年 1 月至 2022 年 8 月间因接受阴囊切除术而行会阴筋膜皮瓣缝合和股前袋成形术的患者的手术细节和手术结果。
共纳入 20 例患者，患者的中位年龄为 64 岁（四分位距 58-70 岁），体重指数为 34（四分位距 29-40），Charlson 合并症指数为 5（四分位距 4-8）。会阴伤口总面积的中位数为 443cm（四分位距 225-600）。所有患者均采用睾丸股前袋和筋膜皮瓣技术进行会阴缝合；18 例患者皮瓣取自大腿，8 例患者取自腹壁。该技术使会阴 100%闭合，3 例患者需要腹部中厚断层皮片（split thickness skin grafting，STSG）移植来完成闭合。有 3 例（15%）患者出现并发症，其中 1 例发生伤口感染，2 例发生出血。40%的患者出院回家。中位随访时间为 9 个月，仅有 1 例患者报告大腿袋相关疼痛，无患者要求选择性阴囊成形术。
尽管存在大的缺陷，但所有患者均完成了会阴闭合，仅少数患者需要使用 STSG。尽管患者身体虚弱，但并发症发生率与其他方法相当，且无患者希望分期行阴囊成形术。这种会阴闭合方法为复杂的会阴重建患者提供了一种选择。
