الفهرس | Only 14 pages are availabe for public view |
Abstract Scrotal defects represent a challenging problem in reconstructive surgery because of its unusual texture, color, thinness, the non-availability of adequate nearby healthy soft tissue and its probability of recurrent faecal and urinary contamination. It is particularly difficult to achieve such perfect reconstruction. All these make the issue of reconstruction complicated There are many reasons for skin defects of the perineo-scrotal area. These defects can result from severe infection and gangrene with loss of the covering skin. Traumatic avulsions of the scrotal and penile skin are commonly caused by clothing being caught in revolving machinery, automobile versus pedestrian accidents, falls, rare bull-horn avulsion injuries, the excision of scrotal skin diseases as neoplasm and genital burns.The most common cause of perineal defects is often Fournier’s gangrene. The goals of scrotal reconstruction is restoration of form and function, reasonable cosmesis with an appropriate coverage of testicles to maintain. spermatogenesis function and hormonal production of Leydig cell. Several reconstructive procedures can achieve wound coverage including direct closure, split-thickness skin graft, full-thickness skin graft, local advancement flap, fasciocutaneous flap, muscle flap or myocutaneous flap. The choice of technique depends on factors related to the defect itself, such as size and location, as well as preferences of the surgical team and the patient. Thus, this study aimed to study different modalities of reconstruction of defects in the scrotum and to verify indications and efficacy of each technique. To elucidate our aim a prospective cross-sectional study was conducted on thirty male patients with a defect of scrotal skin in the plastic surgery and burn department of Menoufia University during the period time from March 2021 to February 2023. Summary 83 All patients were subjected to the following: Preoperative evaluation: History taking including age, onset of symptoms, course of disease and duration of symptoms, Medical history includes diabetes mellitus, alcoholism, and surgical history of previous trauma or surgery, The time interval between the onset of the disease and referral to the hospital. Routine pre-operative investigations: Complete blood count, Kidney function tests (serum urea, creatinine& GFR,), Liver function tests (ALT, AST, Albumin, ALP, AFP, INR &Total/D bilirubin), Coagulation profile. Special investigation including wound swab for culture and sensitivity and Imaging studies as scrotal ultrasound and x-ray. Empiric wide-spectrum antibiotic therapy was initiated till the results of tissue culture were obtained. Then, antibiotic therapy was modified according to the results of tissue culture and sensitivity if there are signs of infection. The result of this study could be summarized as follow: Age was significantly increased among patients under graft technique (45.57±5.74) than patients under direct technique (38.00±9.78) and patients under flap technique (35.75±5.17), (P=0.019). While, there was no significant difference among studied groups regarding nationality (P=0.215). most of causes was infection found in 44.4% of patients under direct technique had infection, and 77.8% of patients under graft technique as well as 100.0% of patients under flap technique had infection with significant different among the studied groups with significant difference among the studied groups (P=0.005). Among direct group, the most lesion were located in scrotum + perineum (n=3, 33.3%), among graft group, the most lesion were located in Scrotum+ bilat groin (n=3, 33.3%) and among flap group, the most lesion were located in partial scrotum (n=5, 41.7%), with significant different among the studied groups (P<0.001). Also, among direct group, the most procedure were Summary 84 located in Scrotal advancement and direct closure (n=7, 77.8%), among graft group, the most procedure were located Stsg (n=4, 44.4%) and among flap group, the most procedure were located medial thigh flap (n=10, 83.3%), with significant different among the studied groups (P<0.001). Follow up time were significantly increased among patients under flap technique (6.83±1.03) than patients under graft technique (6.00±0.00) and patients under direct technique (3.57±0.53), (P<0.001). There was no significant differences among the studied the groups regarding post-operative complications as infection, graft loss and bleeding (P>0.05). While, donner morbidity as dyschromia recorded in 33.3% of patients with graft technique and 100% of patients under flab technique had scar (P<0.001). Also, partial flap necrosis was found in 41.7% of patients with flab compared patients with direct and graft techniques (P=0.017). Also, 2cm wound dehiscence was found in 22.2% of patients with direct technique compared patients with flab and graft techniques (P=0.040). Moreover, postoperative pain was found in 83.3% of patients with flab technique and in 55.6% of patients with graft technique compared patients with direct technique (P=0.012). |