Depending on the extent of skin defects, the options in reconstruction are suturing, split thickness skin grafting, or myocutaneous vascularized pedicle flaps.
Small defects can be closed by primary suturing, especially where only the pliable scrotal skin is involved. Split thickness skin grafting is most often used and yields acceptable results, even in large defects (Hessel-feldt-Nielsen et al. 1986). Healthy skin from the legs, buttocks, and arms can be used, in a single or multiple settings. Skin defects on the penile shaft should be liberally grafted so as to prevent fibrotic scar formation with future erectile problems.
In extensive defects, especially where tendons are exposed, myocutaneous vascularized flaps should be used. Medial thigh flaps, e.g., the gracilis myocutaneo-us pedicle flap, give the best results, because of their close proximity to the perineum, good mobility, and hidden donor site scars (Banks et al. 1986; Paty and Smith 1992; Kayikcioglu 2003). Other flaps using the inferior epigastric arteries can also be considered.
In men with underlying urethral stricture disease, urethroplasty may be extremely difficult or impossible due to extensive loss of penoscrotal skin and even of the urethra itself. Buccal mucosa may be used to reconstruct the urethra, but in some cases with extensive tissue loss, a permanent perineal urethrostomy may be the best solution.
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