A novel technique to construct a neo-scrotum out of preputial skin for agenesis and underdeveloped scrotum.
Michael Benson, MD1, Moneer K. Hanna, MD, FRCS2.
1Rutgers University Newark Medical School, Newark, NJ, USA, 2New York Weill-Cornell, West Orange, NJ, USA.
BACKGROUND: Congenital scrotal agenesis (CSA) is an extremely rare condition with fewer than 10 cases reported in the literature1. These patients are often further complicated by undescended testicles as well as systemic developmental disorders. Different surgical techniques have been utilized to create a functional and aesthetically appearing neo-scrotum. Silay et al. used tissue expanders in the perineum to create a scrotal space and later performed a staged bilateral orchiopexy2. Wright and Verga utilized the Beck-Ombrédanne technique to raise a preputial flap, which was then buttonholed over the penile shaft and glans and secured to the ventral surface of the base of the penis as a neo-scrotum. Herein we report our experience and a novel technique for creation of a neo-scrotum in 3 children.
METHODS: We evaluated the records of 3 children in our data base over the last 5 years aged 6, 14 and 16 months, who were labeled as having an absent (1 pt.) or severely underdeveloped scrotum (2 pts). All patients were uncircumcised and the decision was made to create a neo-scrotum using the foreskin. Double circumcision skin incisions in the penile shaft were made, and an island flap of preputial skin based on a ventral Dartos pedicle was raised. A subcutaneous tunnel was created at the ventral penile shaft and the flap with its pedicle passed through the tunnel and transferred caudally towards the perineum. An incision was made along the median raphe of the perineum which was then manually expanded to accommodate the preputial flap (figure). The flap was allowed to heal for 6 months at which time the orchidopexy was performed.
RESULTS: The follow up to the surgery was; 5 years, 3 years and 2 months. Postoperatively, the flaps appeared edematous, but there were no instances of flap necrosis, dehiscence or wound infection. All 3 children had a capacious scrotal sac which accommodated the testicles in 2/3 and were aesthetically pleasing in all, the third child was operated on recently and awaits bilateral orchidopexy.
CONCLUSIONS: In our experience, a well-vascularized preputial skin flap rotated to the perineum based on its ventral dartos pedicle provides an excellent source of tissue for creation of a neo-scrotum. We believe that the aesthetic outcome of our technique is better than that of the other reported techniques.
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