A hímvessző bőrének helyreállítása szklerotizáló lipogranuloma okozta deformitás miatt

Összefoglaló. Bevezetés: A hímtag körméretének növelése érdekében, az annak bőre alá bejuttatott zsírnemű anyag szklerotizáló lipogranulomát okoz. Hazánkban a szklerotizáló lipogranuloma okozta hímvessző-deformitások kezelésének legelterjedtebb módszere a két ülésben végzett bőrpótlás. Ennek ellenére a magyar nyelvű szakirodalomban kevés adat áll rendelkezésre a kétüléses műtét eredményességéről és várható szövődményeiről. Célkitűzés: Tanulmányunkban a szklerotizáló lipogranuloma okozta deformitások miatti – két ülésben végzett – hímvesszőbőr-helyreállítással szerzett tapasztalatainkról, a műtét után kialakuló szövődményekről számolunk be retrospektív adatgyűjtés alapján. Módszer: 2008. március 1. és 2020. március 1. között a Debreceni Egyetem Urológiai Klinikáján 17 betegen végeztünk kétüléses hímvesszőbőr-helyreállító műtétet. A szklerotizáló lipogranuloma által érintett bőrt teljes mértékben eltávolítottuk, majd a lecsupaszított hímtagot a herezacskó elülső felszínén kialakított subcutan csatornába helyeztük. A második ülés során a herezacskó bőre alá ültetett hímvesszőt felszabadítottuk. Eredmények: A Clavien–Dindo-beosztás szerint az első ülés után három, a második ülés után egy I. gradusú szövődmény alakult ki; II–V. gradusú szövődményt nem figyeltünk meg. Azon 9 beteg közül, akik mindkét ülésen átestek, 7 beteg elégedett volt a beavatkozás eredményével, 2 beteg korrekciós műtéten esett át fél és 9 évvel a második ülés után. A 8 beteg közül, akik csak ez első ülést vállalták, egy korrekciós műtét történt 4 hónappal a műtét után. Következtetés: A hímvessző szklerotizáló lipogranulomája esetén az érintett bőrterület kimetszése után hímvesszőbőr-helyreállítás szükséges. A herezacskó-bőrlebeny alkalmazásának előnye, hogy a herezacskó színe és elaszticitása a hímvesszőbőréhez hasonló, a tapintás- és erogén érzet megmarad. A kétüléses hímvesszőbőr-helyreállítás kevés szövődménnyel, plasztikai sebészeti jártasság nélkül elvégezhető. Orv Hetil. 2021; 162(35): 1413–1417. Summary. Introduction: Subcutaneous injection of liquid fatty materials to enhance penile girth induce sclerosing lipogranuloma of the penis. In spite of its well known severe consequences there has been a persistent use of this practice in non-medical circumstances. Objective: The aim of this paper is to present our observations with staged penile skin reconstruction for sclerosing lipogranuloma and to evaluate postoperative complications in a retrospective manner. Method: Between 2008 and 2020, 17 patients underwent surgery to treat sclerosing lipogranuloma of the penis by staged penile skin reconstruction at our department. Complete exscision of the involved tissue was performed, then the denuded penile shaft was inserted into a subcutaneous channel on the anterior side of the scrotum during the first stage. The second stage of reconstruction consisted of releasing the penile shaft from the scrotum. The second stage was performed merely on 9 in 17 patients. Results: According to the Clavien–Dindo classification system, 3 grade I and 1 grade I complications occurred in the postoperative period after the first and second stage, respectively. Grade II–V complications were not observed. 7 of 9 patients who underwent both stages were satisfied with the final result, 2 patients had minor correction surgery 6 months and 9 years following the second stage. 1 of 8 patients who underwent only the first stage had minor correction surgery 4 months following the operation. Conclusion: In case of sclerosing lipogranuloma of the penis, excision of the affected tissue and reconstruction of the penile skin are indicated. Advantages of using scrotal skin flaps are that colour and elasticity of the scrotal skin are similar to penile skin, erogenous sensation of the scrotal flap remains intact. Applying staged penile skin reconstruction with scrotal skin flap has the advantage of few postoperative complications and it is easy to perform. Orv Hetil. 2021; 162(35): 1413–1417.

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Necrosis of the Ventral Penile Skin Flap: A Complication of Hypospadias Surgery in Children

Advances in Urology ◽

10.1155/2015/452870 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Ünal Bakal ◽

Musa Abeş ◽

Mehmet Sarac

Keyword(s):

Hospital Stay ◽

Skin Flap ◽

Skin Defect ◽

Penile Skin ◽

Penile Shaft ◽

Dartos Flap ◽

The Mean ◽

Hypospadias Surgery ◽

Ventral Skin ◽

Skin Flap Necrosis

Objectives. To review cases of hypospadias that were repaired with TIPU method and consequently resulted in the necrosis of ventral penile skin flaps.Methods. Eighty-three patients with hypospadias underwent TIPU procedure by two surgeons. Neourethra in all patients was covered with dartos flap prepared from the preputium or penile shaft. In cases where ventral skin could not be covered primarily, closure was ensured by using preputial Ombredanne or Byars’ flaps to repair ventral defects.Results. The median age of patients was 4 years. Twenty-five (30.12%) patients that underwent hypospadias repair had urethral opening at the coronal level, 33 (39.75%) at the distal penis, 10 (12.04%) at the midpenis, and 15 (18.07%) at the proximal penis. The ventral skin defect could not be primarily covered in 10 patients with penile shaft hypospadias. Consequently, Byars’ method was used in 8 of these patients to cover the defect and the Ombredanne method was used in the remaining 2. Ventral skin flap necrosis developed in 5 patients (4 Byars and 1 Ombredanne). It was medically treated in 4 patients. Urethral fistula developed in the other patient whose necrosis was deeper. The mean hospital stay was 7 days for patients without necrosis, and 14 for those with necrosis.Conclusion. We are of the opinion that dartos flaps used in the TIPU method in order to cover neourethra and decrease the incidence of fistula development lead to necrosis in the Ombredanne or Byars’ flaps by causing low blood supply to the preputium and thus extend hospital stay.

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Penile Reconstruction for a Case of Genital Lymphoedema Secondary to Proteus Syndrome

ISRN Urology ◽

10.5402/2011/431536 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

F. Ashouri ◽

J. Manners ◽

R. Rees

Keyword(s):

Urinary Catheter ◽

Sexual Debut ◽

Proteus Syndrome ◽

Main Concern ◽

Penile Skin ◽

Penile Shaft ◽

Cosmetic Appearance ◽

Minimal Scarring ◽

Thickness Skin

To our knowledge penile lymphoedema secondary to Proteus syndrome has not previously been reported. Hence we report a case of a 16-year-old male who was referred with features of right hemi-hypertrophy and severe lymphoedema affecting his scrotum and penis. He had previously undergone scrotal reduction surgery at the age of 13, but had since developed worsening penile oedema. His main concern was that of cosmetic appearance prior to sexual debut, and he also complained of erectile dysfunction. An MRI confirmed gross oedema of the penile skin, but normal underlying cavernosal structure, and no other anatomical abnormality. Under general anaesthesia, the entire diseased penile skin was excised. Two full thickness skin grafts were harvested from the axillae, and grafted onto the dorsal and ventral penile shaft respectively. A compressive dressing and urinary catheter was applied for 7 days. Follow-up at 4 months confirmed complete graft take with minimal scarring, and the patient was very satisfied with the cosmetic outcome. He had also noticed a recovery in erectile activity, and feels psychologically and physically more prepared for sexual relations.

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Early outcome of combined dorsal onlay graft urethroplasty with ventral strip anastomosis or onlay penile skin flap

European Urology Supplements ◽

10.1016/s1569-9056(02)80336-0 ◽

2002 ◽

Vol 1 (1) ◽

pp. 87

Author(s):

Christophe Iselin ◽

Farshid Fateri

Keyword(s):

Skin Flap ◽

Penile Skin ◽

Early Outcome ◽

Onlay Graft ◽

Dorsal Onlay

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Reconstruction of Tragus and External Auditory Meatus using Remnant Auricle during Microtia Reconstruction

Facial Plastic Surgery ◽

10.1055/s-0037-1617436 ◽

2018 ◽

Vol 34 (02) ◽

pp. 227-229

Author(s):

Yi-gao Hu ◽

Wei Ding ◽

Jun Tan ◽

Xin Chen ◽

Tao Luo ◽

...

Keyword(s):

Skin Flap ◽

Skin Grafting ◽

External Auditory Meatus ◽

Reconstruction Technique ◽

External Ear ◽

Flap Necrosis ◽

Second Stage ◽

The Third ◽

Third Stage ◽

Thin Skin

AbstractThis article investigates an effective method with which to reconstruct the tragus and external auditory meatus for microtia reconstruction. The external ear was reconstructed using a delayed postauricular skin flap in patients with congenital microtia. After the first stage of delaying the postauricular skin flap and the second stage of otoplasty with ear framework fabricated from autogenous rib cartilage draping with the delayed skin flap, the third stage involved tragus and external auditory meatus canaloplasty. After designing the remnant auricle flap, the lower part was trimmed and the tragus was reconstructed. The upper part was trimmed into a thin skin flap, which was rotated and used to cover the hollowed wound posterosuperior to the tragus so as to mimic the external auditory meatus. If remnant wounds were present, skin grafting was conducted. In total, 121 patients with congenital microtia were treated from March 2010 to March 2016. The reconstructed tragus and external auditory meatus were well formed, and all wounds healed well. No severe complications such as flap necrosis occurred. Six months postoperatively, the morphology of the reconstructed tragus and external auditory meatus was good. Overall, the patients and their families were satisfied. The use of remnant auricle to reconstruct the tragus and external auditory meatus is an effective auricular reconstruction technique.

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Systematic Review and Meta-analysis of Complications Following Mastectomy and Prosthetic Reconstruction in Patients With and Without Prior Breast Augmentation

Aesthetic Surgery Journal ◽

10.1093/asj/sjab028 ◽

2021 ◽

Author(s):

Maria Chicco ◽

Ali R Ahmadi ◽

Hsu-Tang Cheng

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Meta Analysis ◽

Skin Flap ◽

Prosthetic Reconstruction ◽

Hematoma Formation ◽

Significant Difference ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Early Late

Abstract Background There is limited evidence available in literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients. Objectives The purpose of this systematic review and meta-analysis is to compare postoperative complications between women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. Methods A systematic search was conducted in February 2020 for studies comparing women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late and overall complications. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were obtained through meta-analysis. Results Our meta-analysis, which included six studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the two groups in rates of early (36.7% vs. 24.8%; OR=1.57, 95% CI 0.94 to 2.64; P=0.09), late (10.1% vs. 19.9%; OR=0.53, 95% CI 0.06 to 4.89; P=0.57) and overall complications (36.5% vs. 31.2%; OR=1.23, 95% CI 0.76 to 2.00; P=0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% versus 2.15%; OR=2.68, 95% CI 1.00 to 7.16; P=0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis and prosthesis loss. Conclusions Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.

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The use of penile skin graft versus penile skin flap in the repair of long bulbo-penile urethral stricture: a prospective randomized study

International braz j urol ◽

10.1590/s1677-55382011000100023 ◽

2011 ◽

Vol 37 (1) ◽

pp. 124-125

Author(s):

Sean P. Elliott

Keyword(s):

Urethral Stricture ◽

Skin Graft ◽

Skin Flap ◽

Randomized Study ◽

Prospective Randomized Study ◽

Penile Skin

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Posoncological Cutaneous Reconstruction of Penis with Scrotum Flaps about a Case

Journal of Advanced Plastic Surgery Research ◽

10.31907/2414-2093.2019.05.02 ◽

2019 ◽

Vol 5 (2) ◽

pp. 4-8

Author(s):

Humberto Miguel Pontillo ◽

◽

Jhorbet C. Rodríguez Castillo ◽

Tolentino Dos Santos ◽

Keyword(s):

Skin Flap ◽

Cell Cancer ◽

Surgical Techniques ◽

Psychological Trauma ◽

Developed Countries ◽

Inguinal Lymph Node Dissection ◽

Inguinal Lymphadenectomy ◽

Skin Reconstruction ◽

Keywords Cancer ◽

The Developed Countries

!Objective: The penile cancer is a rare entity in the developed countries and its incidence increases in the developing countries, achieving up to 10% of the malignancies in men. There is a crucial association with the HPV, in the same way it relates to inadequate hygiene habits and the phimosis. The objective of the surgical treatment is resection with adequate margins, and the inguinal lymph node dissection when indicated. The restore skin coverage in these lesions is a challenge for the surgeon, as it seeks to achieve a phallus almost normal appearance, and restore the patient's tactile and the erogenous function, with the fewest possible interventions, trying to minimize the psychological trauma. Previously, many of these patients were considered inoperable and were recommended to radiation therapy to cure the injury. The evolution of the plastic surgical techniques using skin or the myocutaneous flaps, have provided the surgeon another option to keep the local oncological control with acceptable morbidity. Clinical Case: The aim of this paper is to present the case of a 56 years old male patient with diagnostic of squamous cell cancer of the penis stage II, who underwent the penile stripping, with bilateral inguinal lymphadenectomy; and rotation flap reconstruction of the scrotal skin. We found no published paper about the skin reconstruction of penile skin flap from scrotum for cancer patients, hence the importance of this work. Keywords: Cancer, Penile, HPV, Reconstruction, Faloplastia.

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Surgical Correction of Penoscrotal Web: A Case Series With Literature Review

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2020.62134 ◽

2020 ◽

Author(s):

Volkan Sarper Erikçi

Keyword(s):

Surgical Treatment ◽

Clinical Characteristics ◽

Surgical Techniques ◽

Case Series ◽

Scrotal Skin ◽

Penile Skin ◽

Surgical Experience ◽

Postoperative Results ◽

Pediatric Urologist

INTRODUCTION: Penoscrotal webbing (PSW) is an anomaly of penis and it includes penile and scrotal skin aberration. There are various surgical techniques for repairing PSW with different terminologies. Herein we present our surgical experience of Z-plasty procedure in these cases. METHODS: In this retrospective study, 5 patients with an average age of 46 months who were diagnosed and under follow-up for PSW, between June 2017 and May 2019 were included. Along with demographic and clinical characteristics, treatment and follow-up records were collected. RESULTS: Isolated PSW was observed in 4 patients and one patient had an associated megameatus intact prepuce (MMIP) of a hypospadias variant in addition to PSW. Circumcision and ventral prepuce reconstruction of the penis with the aid of "Z-plasty" solved problem and acceptable postoperative results were obtained. DISCUSSION AND CONCLUSION: PSW is a condition that warrants surgical treatment. During the management of these children, in the case of suspicion of penile skin abnormality at the time of circumcision, it should be deferred and should be consulted to a pediatric surgeon or a pediatric urologist. Gentle surgical treatment is recommended for a favourable surgical and psychological result

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