RECONSTRUCTION OF PENO-SCROTAL INJURIES

Presented by:

Dr. Iftekhar Ibne Mannan

Dept. of Plastic Surgery, DMCH

Authors Iftekhar I. Mannan Rayhana Awwal Shafquat H. Khundkar

Place of study Department of Plastic Surgery

Dhaka Medical College Hospital Department of Casualty Surgery

Dhaka Medical College Hospital

Background Peno-scrotal injuries are rarely life

threatening and therefore has not received much importance in the trauma units of our country. The quality of management of such injuries seriously influences the subsequent sexual and reproductive function of the patient. Thus it has a significant long term effect on the quality of life.

BackgroundManagement of defects in penoscrotal region can be quite challenging. Location, size, shape, and orientation of the defects are important factors in determining the method used in reconstruction.

Patients and Methods The study was carried out from January

2009 to November 2009 in Dhaka Medical College Hospital. All patients that were admitted under Plastic Surgery Department within this period with injury in the penoscrotal region were included in this study.

Patients and Methods A total of 23 patients were observed. 12 patients were referred from casualty

on the day of the injury. 9 patients were referred after 24 hours or

more. 2 patients were admitted from the SOPD

Patients and Methods In the first 48 hours, surgery was

performed in the Casualty OT as emergency procedures

After 48 hours, surgery was performed in the Plastic Surgery OT as elective procedures

Age distributionAge group Cases Percentage

0 – 10 years 5 21.7%

11 – 20 years 6 26.1%

21 – 30 years 7 30.4%

31 – 40 years 3 13.1%

41 – 50 years 0 -------

51 – 60 years 2 8.7%

Types of Injury

Site Type Cases Percentage

Penile injury

Degloving 6 26.1%

Amputation 3 13.1%

Crush 1 4.3%

Scrotal injury

Partial avulsion 3 13.1%

Total avulsion 1 4.3%

Combined injury

Mixed 9 39.1%

Partially degloved penis

Completely degloved penis

Amputated penis

Crushed penis

Combined penoscrotal injury

Combined penoscrotal loss

Mode of injuryEvents Cases Age group

Machinery accident

12 Adult – 12Child – 0

Road accident 8 Adult – 0Child – 8

Assault 2 Adult – 2Child – 0

Self inflicted 1 Adult – 1Child – 0

Reconstruction of Penile Defects

Techniques Cases Percentage

Primary repair 5 26.3%

Secondary repair 1 5.3%

Early skin graft 5 26.3%

Delayed skin graft 8 42.1%

Primary repair

Secondary repair

Early Skin Graft

Delayed Skin Graft

Replantation of Penis

Reconstruction of Scrotal DefectsTechniques Cases Percentage

Primary repair 8 61.5%

Delayed repair 2 15.4%

Thigh flap 2 15.4%

Skin graft 1 7.7%

Repair of Scrotum

Unilateral Thigh Flap

Bilateral Thigh Flap

ComplicationsComplication Cases Percentage

Wound infection 10 43.5%

Major graft loss 0 --------

Minor graft loss 6 26.1%

Flap necrosis 0 --------

Tip necrosis 2 8.7%

Replant failure 1 4.3%

Hospital StayCatagory Cases Mean Hospital Stay

All patients 23 39.5 days

Immediate referrals

12 19.0 days

Delayed referrals

11 61.9 days

Discussion In the recent studies,

split skin graft has been found to be the most satisfactory method for covering penile skin loss.

One author however recommended full thickness skin graft.

Discussion Scrotal skin avulsions require additional

judgment for the treatment. Scrotal skin remnants must be used to

cover whenever possible. Skin grafts have shown better fertility at

the cost of tenderness. Abdominal flaps may also be used for

scrotal reconstruction

Thank You