Urethroplasty of Urethral Defect with Longitudinal Tubed Flap of Scrotal Skin after Fournier's Gangrene (Necrotizing Fascitis)

회음부 괴사성 근막염후 발생한 요도 결손의 치료를 위한 음낭피부 종축관피판을 이용한 요도성형술

  • Min, Hee-Joon (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Roh, Tai-Suk (Department of Plastic and Reconstructive Surgery, Kangnam Severance Hospital) ;
  • Kim, Ji-Ye (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Kim, Sug-Won (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine)
  • 민희준 (연세대학교 원주의과대학 원주기독병원 성형외과학교실) ;
  • 노태석 (강남세브란스병원 성형외과학교실) ;
  • 김지예 (연세대학교 원주의과대학 원주기독병원 성형외과학교실) ;
  • 김석원 (연세대학교 원주의과대학 원주기독병원 성형외과학교실)
  • Received : 2010.04.30
  • Accepted : 2010.08.10
  • Published : 2010.09.10

Abstract

Purpose: The management of urethral defect represents one of the most challenging clinical problems in uroplastic surgery. Especially for defect after Fournier's Gangrene, optimal management is still a hard problem. During extensive urethral reconstruction, to overcome the poor vascularity due to periurethral scarred tissue and limitation of the choice of local flap, we report our experience with one-stage reconstruction of urethral defect using a longitudinal tubed flap of scrotal skin. Methods: A 72-year-old man with several years of diabetes mellitus history visited for swelling and pain of scrotal area. After diagnosis of Fournier's Gangrene, radical debridement was performed and 6 cm of urethral defect on border of penile-scrotal ventral area was made. Rectangular scrotal skin flap ($6{\times}2.5\;cm$) based on external spermatic fascia was elevated and tubed longitudinally. After transfer the flap to the defect area, end-to-end anastomosis was performed bilaterally. Results: 4 weeks after the operation, the patient started voiding him-self and urethrography showed good fluence of contrast agent. Long term evaluation reveals stable performance characteristics without any complications. Conclusion: We suggest a one-stage reconstruction of extensive urethral defect using a longitudinal tubed flap of scrotal skin. Advantages of this procedures are simple, one-stage reconstruction with the reliable scrotal skin flap based on external spermatic fascial vasculature, and no donor morbidity.

Keywords

References

  1. Jordan GH, Devine PC: Management of urethral stricture disease. Clin Plast Surg 15: 493, 1988
  2. Devine PC, Fallon B, Devin CJ: Free full thickness skin graft urethroplasty. J Urol 116: 444, 1976 https://doi.org/10.1016/S0022-5347(17)58851-5
  3. Morey AF, McAninch JW: When and hoe to use buccal mucosal grafts in adult bulbar urethroplasty. Urology 48: 194, 1996 https://doi.org/10.1016/S0090-4295(96)00154-9
  4. Koshima I, Inagawa K, Okuyama N, Moriguchi T: Free vascularized appendix transfer for reconstruction of penile urethra with severe fibrosis. Plast Reconstr Surg 103: 964, 1999 https://doi.org/10.1097/00006534-199903000-00030
  5. Gil-Vernet J, Arango O, Gil-Vernet A, Gil-Vernet J Jr, Gelabert-Mas A: a new biaxial epilated scrotal flap for reconstructive urethral surgery. J Urol 158: 412, 1997 https://doi.org/10.1016/S0022-5347(01)64491-4
  6. Morrison WA, Webster HR, Kumata S: Urethral reconstruction using the radial artery forearm free flap: conventional and prefabricated. Plast Reconstr Surg 97: 413, 1996 https://doi.org/10.1097/00006534-199602000-00021
  7. Lee HB, Hur JY, Song JM, Tark KC: Long anterior urethral reconstruction using a sensate ulnar forearm free flap. Plast Reconstr Surg 108: 2053, 2001 https://doi.org/10.1097/00006534-200112000-00033
  8. Orandi A: One-Stage urethroplasty. Br J Urol 40: 717, 1968 https://doi.org/10.1111/j.1464-410X.1968.tb11872.x