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

Min, Hee Joon; Roh, Tai Suk; Kim, Ji Ye; Kim, Sug Won

Search: J Korean Soc Plast Reconstr Surg Search

CLOSE

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(5):667-670.
Published online September 1, 2010.

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

Hee Joon Min, Tai Suk Roh, Ji Ye Kim, Sug Won Kim

¹Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea. sugwonkim@yonsei.ac.kr
²Department of Plastic and Reconstructive Surgery, Kangnam Severance Hospital, Seoul, Korea.

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 x 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

TOOLS