Presented on 11 December 2011 in the 12th International Surgical Congress organized by the Society of Surgeons of Bangladesh

2. RECONSTRUCTION OF
PENO-SCROTAL INJURIES
Presented by:
Dr. Iftekhar Ibne Mannan
Dept. of Plastic Surgery, DMCH

3. Authors
 Iftekhar I. Mannan
 Rayhana Awwal
 Shafquat H. Khundkar

4. Place of study
 Department of Plastic Surgery
Dhaka Medical College Hospital
 Department of Casualty Surgery
Dhaka Medical College Hospital

5. Background
 Peno-scrotal injuries are rarely life
threatening and therefore has not
received much importance in the trauma
units of our country. The quality of
management of such injuries seriously
influences the subsequent sexual and
reproductive function of the patient. Thus
it has a significant long term effect on the
quality of life.

6. Background
Management of defects
in penoscrotal region can
be quite challenging.
Location, size, shape,
and orientation of the
defects are important
factors in determining the
method used in
reconstruction.

7. Patients and Methods
 The study was carried out from January
2009 to November 2009 in Dhaka
Medical College Hospital. All patients
that were admitted under Plastic Surgery
Department within this period with injury
in the penoscrotal region were included
in this study.

8. Patients and Methods
A total of 23 patients were observed.
 12 patients were referred from casualty
on the day of the injury.
 9 patients were referred after 24 hours or
more.
 2 patients were admitted from the SOPD

9. Patients and Methods
 In the first 48 hours, surgery was
performed in the Casualty OT as
emergency procedures
 After 48 hours, surgery was performed in
the Plastic Surgery OT as elective
procedures

10. Age distribution
Age group Cases Percentage
0 – 10 years 5 21.7%
11 – 20 years 6 26.1%
21 – 30 years 7 30.4%
31 – 40 years 3 13.1%
41 – 50 years 0 -------
51 – 60 years 2 8.7%

11. Types of Injury
Site Type Cases Percentage
Penile Degloving 6 26.1%
injury Amputation 3 13.1%
Crush 1 4.3%
Scrotal Partial avulsion 3 13.1%
injury Total avulsion 1 4.3%
Combined Mixed 9 39.1%
injury

12. Partially degloved penis

13. Completely degloved penis

14. Amputated penis

15. Crushed penis

16. Combined penoscrotal injury

17. Combined penoscrotal loss

18. Mode of injury
Events Cases Age group
Machinery 12 Adult – 12
accident Child – 0
Road accident 8 Adult – 0
Child – 8
Assault 2 Adult – 2
Child – 0
Self inflicted 1 Adult – 1
Child – 0

19. Reconstruction of Penile Defects
Techniques Cases Percentage
Primary repair 5 26.3%
Secondary repair 1 5.3%
Early skin graft 5 26.3%
Delayed skin graft 8 42.1%

20. Primary repair

21. Secondary repair

22. Early Skin Graft

23. Delayed Skin Graft

24. Replantation of Penis

25. Reconstruction of Scrotal
Defects
Techniques Cases Percentage
Primary repair 8 61.5%
Delayed repair 2 15.4%
Thigh flap 2 15.4%
Skin graft 1 7.7%

26. Repair of Scrotum

27. Unilateral Thigh Flap

28. Bilateral Thigh Flap

29. Complications
Complication Cases Percentage
Wound infection 10 43.5%
Major graft loss 0 --------
Minor graft loss 6 26.1%
Flap necrosis 0 --------
Tip necrosis 2 8.7%
Replant failure 1 4.3%

30. Hospital Stay
Catagory Cases Mean Hospital Stay
All patients 23 39.5 days
Immediate 12 19.0 days
referrals
Delayed 11 61.9 days
referrals

31. Discussion
 In the recent studies,
split skin graft has
been found to be the
most satisfactory
method for covering
penile skin loss.
 One author however
recommended full
thickness skin graft.

32. Discussion
 Scrotal skin avulsions require additional
judgment for the treatment.
 Scrotal skin remnants must be used to
cover whenever possible.
 Skin grafts have shown better fertility at
the cost of tenderness.
 Abdominal flaps may also be used for
scrotal reconstruction

33. Thank
You