الفهرس 
Aim of the studyOnly 14 pages are availabe for public view
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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
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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).