Tissue Expander Scrotal Reconstruction

Abstract

Fournier's gangrene is a life-threatening soft tissue infection requiring aggressive debridement of the perineum. Surgical debridement results in large defects of the scrotum requiring reconstruction for functional coverage of the testes. Several studies have described scrotal reconstruction utilizing split thickness skin grafts or local flaps. These procedures create additional morbidity in an unhealthy patient population. This report describes a patient who presents for delayed scrotal reconstruction utilizing tissue expansion. Tissue expander-based reconstruction provides reconstruction of native scrotal soft tissue without additional donor site morbidity. A 40-year-old man presented to an outside hospital with Fournier's gangrene and underwent significant soft tissue debridement. He had an almost complete loss of his native scrotum with his testes surgically banked in his bilateral thighs. He presented to our clinic for a delayed scrotoplasty. The patient was taken to the operating room and a single tissue expander was inserted into the perineum. He underwent serial insufflations in the clinic setting and returned to the operating room for expander removal and scrotal reconstruction. The patient followed up in clinic 4 months postoperatively with a well-healed scrotoplasty. Our case report demonstrates a 2-stage procedure for patients presenting with significant soft tissue loss of the perineum. This reproducible method of reconstruction can be considered for excellent aesthetic and functional scrotoplasty.

Fig. 1.

Preoperative markings indicating planned pocket placement of a tissue expander. Patient had significant loss of volume of scrotum with superior band tethering the shaft of the penis.

Fig. 2.

Postoperative placement of the tissue expander with 4 cm incision at left aspect superior to scrotum and port site located suprapubic region and demarcated with silk suture for future clinic insufflations.

Fig. 3.

The urology team harvested the testes from the bilateral thighs and performed an orchiopexy in the new scrotal pocket.

Fig. 4.

Four-month outpatient follow-up from tissue expander scrotoplasty with well-healed scrotal incision and reconstruction.