Complete avulsion of penile and scrotal skin: Emergency one-off repair

Objective To explore the application of flap transfer to the skin of the penis and scrotum for repairing large area of avulsion.Methods There were 8 patients with complete avulsion of penile and scrotal skin in author's hospital from 1999 to 2012yr.,among them 6 cases were of machine strangulation injury,2 cases of crush injury associated with multiple organ injury,2 cases of one side of the spermatic cord complete fracture and testis removal.All the cases were treated by axial flap,which was from perineal adjacent area,7 cases of whom were operated on within 6 hours after injury;1 case was operated on within 72 hours after injury and were obeserved for necrosis outborn after the avulsed skin suture in situ.Results All the cases were treated by one-off repair operation successfully.All the flaps healed well found by postoperative follow-up of 1-4years,postoperative penile morphology of one patient was slightly bloated and subjected to a subcutaneous fibrous tissue resection operation.The size of skin flap margin necrosis of 1 case was approximately 1.5 cm×3.0 cm,which was no dysfunction although scar formation after 1 year.The rest cases had no erectile dysfunction,testis atrophy and urethral stricture.Conclusion The patients with the severe penis and scrotum avulsion injuries due to perineal injury should be subjected to an accurate assessment on the extent of injury,and repaired with selecting transfer flap under emergency.At the same time of keeping vital signs stable,the first consideration should be given to the penis,testicles,spermatic cord and other important organ for function protection,and according to the degree of injury and skin damage to determine the flap to be transfered so that just the best treatment effect can be obtained prespectively.