New Technique of Plastic Reconstruction Using Scrotal Skin Pedicle Graft in Penile Skin Defect

Kim, Young Soo; Chung, Kwang Sup; Kim, Se Kyong

Abstract

A new technique of plastic reconstruction of penile skin using scrotal skin pedicle graft was devised This technique was applied in 6 patients who were admitted to the Department of Urology, Korea University Hospital during the period of 5 years and 6 months from January 1974 to June 1979 and the results were excellent in all cases. The primary causes of penile skin defect in these patients were injection of paraffin into the subcutaneous tissues of the penile shaft(4 Pts.) and tissue necrosis resulted from infiltration of local anesthetics for performing circumcision (2 Pts.). The procedure was as follows: 1st stage; With the patient in supine position, under general orspinal anesthesia, the removal of paraffin or fibrotic tissues and necrotic tissues were carried out After the length of penile skin defect was measured and the same length was applied in making three parallel transverse incisions over the scrotal skin and the skin between these incisions was undermined to from two tunnels underneath. The penis was drawn downward through the proximal tunnel to cover the denuded area over the dorsal side of the penis and the glans was exposed. Both the proximal and distal borders of the proximal tunnel were approximated to healthy skin borders of dorsal aspect of the penis. The scrotal skin flap forming distal tunnel was then reversed inside out inwardly and upwardly and approximated the proximal and distal borders with healthy skin borders of distal and proximal borders of ventral aspect of the penis so that the ventral denuded area of the penis could be covered. Then the denuded scrotal skin was closed by approximation of remained scrotal skin edges. Sutures. were carried out in interrupted manner with 4-O Nylon except the ventral side of proximal portion of the penis and closure of the scrotal skin, where 3-0 catgut were used. 2nd stage; After healing had taken place the penis was freed by simple dissection of two lateral pediclcs from the scrotum under local anesthesia. Then simple closure was performed on every dissected borders. The advantages of this technique are as follows: 1. Indwelling of urethral catheter or urinary diversion such as suprapubic cystostomy isnot necesssry in first stage operand and the patient can void urine without difficulty. 2. No discomfort or pain is complained on erection of the penis because the penis is lifted away from the scrotum by the reversed scrotal skin flap. 3. The second stage of this operation is so simple that the procedure is performed under local anesthesia. 4. There isono danger of urethral injury in second stage operation