The clinical study of partial perineum area and wound repair in males_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Peng ^1,2 , ZHENG Junshui ³ ^Δ , WU Yibing ² , CHEN Linhai ³ , WANG Yangjian ² , YANG Fan ¹ ,  XU Youjia ¹

1. Department of Othopaedics, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China;
2. Department of Plastic and Reconstructive Surgery, Ningbo First Hospital, Ningbo Zhejiang, 315000, P.R.China;
3. Medical School of Ningbo University, Ningbo Zhejiang, 315000, P.R.China;

Corresponding?author：

XU Youjia, Email: xuyoujia@suda.edu.cn

Keywords：

Male genitalia; division; skin flap; repair

DOI：

10.7507/1002-1892.202003154

Video：

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Objective To explore the suitable division of male genitalia subunits and the effectiveness of large-area perineum defect repair under its guidance.Methods According to the anatomical and functional characteristics of male genitalia, the subunit division scheme was proposed: area Ⅰ, glans penis; area Ⅱ, body of penis; area Ⅲ, scrotum; area Ⅳ, scrotum. Between April 2017 and July 2019, 12 patients with large genitalia defects were treated, with an average age of 60.9 years (range, 57-66 years) and an average disease duration of 2.7 years (range, 2-5 years). The defect area involved area Ⅰ in 1 case, area Ⅱ in 7 cases, area Ⅲ in 5 cases, and area Ⅳ in 8 cases; the size of area ranged from 6 cm×4 cm to 23 cm×16 cm. The causes of defect included 3 cases of trauma, 6 cases of Paget disease, 2 cases of squamous cell carcinoma, 1 case of spindle cell tumor. According to the design of the corresponding repair scheme, the main repair methods were to rotate and advance the skin flap and pedicled skin flap in the same area. When the defect was large, the free skin flap transplantation, free skin grafting, and free mucosa transplantation were used to repair the defect.Results All the patients were followed up 6-13 months with an average of 8.6 months. Skin flap, skin graft, and mucosa survived in one stage in 10 patients; infection occurred in 1 case after the scrotal flap of area Ⅲ was transferred to repair the defect in area Ⅱ, 1 case had distal venous crisis at 2 days after repair area Ⅲ defect used free anterolateral thigh flap, and after active treatment, the condition improved. The appearance of the receiving area and the supplying area was good, and the local feeling was recovered satisfactorily. The range of motion of hip joint was good in 10 cases, and 2 cases were slightly stretched but did not affect normal life. All patients had normal urination and defecation function, and were satisfied with the treatment effectiveness.Conclusion The subunits of male genitalia can be used to guide the repair of the defect, which can better restore the physiological appearance and function, and has positive clinical significance.

Citation： WEI Peng, ZHENG Junshui, WU Yibing, CHEN Linhai, WANG Yangjian, YANG Fan, XU Youjia. The clinical study of partial perineum area and wound repair in males. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1288-1293. doi: 10.7507/1002-1892.202003154 Copy

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2.	Tan A, Bieber AK, Stein JA, et al. Diagnosis and management of vulvar cancer: A review. J Am Acad Dermatol, 2019, 81(6): 1387-1396.
3.	Mericli AF, Martin JP, Campbell CA. An algorithmic anatomical subunit approach to pelvic wound reconstruction. Plast Reconstr Surg, 2016, 137(3): 1004-1017.
4.	宋慧鋒, 許明火, 高全文, 等. 會陰部亞單位缺損修復重建方案. 中華整形外科雜志, 2019, 35(5): 436-440.
5.	陳林海, 林光豪, 陳芝武, 等. 重建感覺的股前外側穿支皮瓣修復會陰部 Paget 病根治術后軟組織缺損的療效分析. 中華整形外科雜志, 2019, 35(9): 907-912.
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8.	袁宇雯, 李海州, 顧斌, 等. 微泡增強多普勒超聲技術在鎖骨上動脈穿支皮瓣設計中的應用. 中華整形外科雜志, 2015, 31(1): 14-18.
9.	唐舉玉, 魏在榮, 張世民, 等. 穿支皮瓣的臨床應用原則專家共識. 中國臨床解剖學雜志, 2016, 34(1): 4-5.
10.	王芳, 宋慧鋒. 旋髂淺動脈穿支皮瓣的研究進展. 中華損傷與修復雜志 (電子版), 2016, 11(5): 378-381.
11.	Kadota H, Momii K, Hanada M, et al. Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in fournier’s gangrene: A case report. Microsurgery, 2019, 39(3): 263-266.
12.	宋達疆, 李贊, 周曉, 等. 帶蒂股前外側肌皮瓣修復腹壁腫瘤術后全層缺損. 中國修復重建外科雜志, 2019, 33(6): 712-716.
13.	趙民, 吳金英, 袁作雄, 等. 前臂橈背側穿支皮瓣游離移植修復手指皮膚缺損. 中國修復重建外科雜志, 2019, 33(5): 586-589.
14.	晏曉青, 楊紅巖, 由磊, 等. 應用腹壁下動脈穿支島狀皮瓣修復會陰部軟組織缺損. 中國實用美容整形外科雜志, 2006, 17(1): 24-26.
15.	劉元波, 范金財, 焦鵬, 等. 腹壁下動脈穿支島狀皮瓣修復會陰部瘢痕攣縮. 中華整形外科雜志, 2008, 24(1): 79-80.
16.	程開祥, 劉陽, 沈國雄. 陰莖再造術的臨床對比研究. 組織工程與重建外科雜志, 2005, 1(4): 232-233, 236.
17.	ünverdi ?F, Kemalo?lu CA. A reliable technique in the reconstruction of large penoscrotal defect: Internal pudendal artery perforator flap. Urology, 2019, 128: 102-106.

1. 呂夢竹, 郭澍, 唐明睿, 等. 會陰部缺損修復的方法及原則: 附一例病例報道及文獻學習. 中國美容整形外科雜志, 2015, 26(4): 215-216.
2. Tan A, Bieber AK, Stein JA, et al. Diagnosis and management of vulvar cancer: A review. J Am Acad Dermatol, 2019, 81(6): 1387-1396.
3. Mericli AF, Martin JP, Campbell CA. An algorithmic anatomical subunit approach to pelvic wound reconstruction. Plast Reconstr Surg, 2016, 137(3): 1004-1017.
4. 宋慧鋒, 許明火, 高全文, 等. 會陰部亞單位缺損修復重建方案. 中華整形外科雜志, 2019, 35(5): 436-440.
5. 陳林海, 林光豪, 陳芝武, 等. 重建感覺的股前外側穿支皮瓣修復會陰部 Paget 病根治術后軟組織缺損的療效分析. 中華整形外科雜志, 2019, 35(9): 907-912.
6. 謝昆, 溫冰, 翟偉, 等. 穿支皮瓣在修復會陰區腫瘤術后缺損中的應用. 中華整形外科雜志, 2018, 34(9): 704-708.
7. 唐茂林, 楊大平, 梅勁, 等. 穿支皮瓣的解剖學及血流動力學研究進展. 中華顯微外科雜志, 2016, 39(3): 312, 后插 1-后插 3.
8. 袁宇雯, 李海州, 顧斌, 等. 微泡增強多普勒超聲技術在鎖骨上動脈穿支皮瓣設計中的應用. 中華整形外科雜志, 2015, 31(1): 14-18.
9. 唐舉玉, 魏在榮, 張世民, 等. 穿支皮瓣的臨床應用原則專家共識. 中國臨床解剖學雜志, 2016, 34(1): 4-5.
10. 王芳, 宋慧鋒. 旋髂淺動脈穿支皮瓣的研究進展. 中華損傷與修復雜志 (電子版), 2016, 11(5): 378-381.
11. Kadota H, Momii K, Hanada M, et al. Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in fournier’s gangrene: A case report. Microsurgery, 2019, 39(3): 263-266.
12. 宋達疆, 李贊, 周曉, 等. 帶蒂股前外側肌皮瓣修復腹壁腫瘤術后全層缺損. 中國修復重建外科雜志, 2019, 33(6): 712-716.
13. 趙民, 吳金英, 袁作雄, 等. 前臂橈背側穿支皮瓣游離移植修復手指皮膚缺損. 中國修復重建外科雜志, 2019, 33(5): 586-589.
14. 晏曉青, 楊紅巖, 由磊, 等. 應用腹壁下動脈穿支島狀皮瓣修復會陰部軟組織缺損. 中國實用美容整形外科雜志, 2006, 17(1): 24-26.
15. 劉元波, 范金財, 焦鵬, 等. 腹壁下動脈穿支島狀皮瓣修復會陰部瘢痕攣縮. 中華整形外科雜志, 2008, 24(1): 79-80.
16. 程開祥, 劉陽, 沈國雄. 陰莖再造術的臨床對比研究. 組織工程與重建外科雜志, 2005, 1(4): 232-233, 236.
17. ünverdi ?F, Kemalo?lu CA. A reliable technique in the reconstruction of large penoscrotal defect: Internal pudendal artery perforator flap. Urology, 2019, 128: 102-106.

Chinese Journal of Reparative and Reconstructive Surgery

The clinical study of partial perineum area and wound repair in males

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