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

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)
Publication Information
Archives of Plastic Surgery / v.37, no.5, 2010 , pp. 667-670 More about this Journal
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
Urethroplasty; Urethral reconstruction; Fournier's Gangrene;
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