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

1.	吕梦竹, 郭澍, 唐明睿, 等. 会阴部缺损修复的方法及原则: 附一例病例报道及文献学习. 中国美容整形外科杂志, 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.	宋慧锋, 许明火, 高全文, 等. 会阴部亚单位缺损修复重建方案. 中华整形外科杂志, 2019, 35(5): 436-440.
5.	陈林海, 林光豪, 陈芝武, 等. 重建感觉的股前外侧穿支皮瓣修复会阴部 Paget 病根治术后软组织缺损的疗效分析. 中华整形外科杂志, 2019, 35(9): 907-912.
6.	谢昆, 温冰, 翟伟, 等. 穿支皮瓣在修复会阴区肿瘤术后缺损中的应用. 中华整形外科杂志, 2018, 34(9): 704-708.
7.	唐茂林, 杨大平, 梅劲, 等. 穿支皮瓣的解剖学及血流动力学研究进展. 中华显微外科杂志, 2016, 39(3): 312, 后插 1-后插 3.
8.	袁宇雯, 李海州, 顾斌, 等. 微泡增强多普勒超声技术在锁骨上动脉穿支皮瓣设计中的应用. 中华整形外科杂志, 2015, 31(1): 14-18.
9.	唐举玉, 魏在荣, 张世民, 等. 穿支皮瓣的临床应用原则专家共识. 中国临床解剖学杂志, 2016, 34(1): 4-5.
10.	王芳, 宋慧锋. 旋髂浅动脉穿支皮瓣的研究进展. 中华损伤与修复杂志 (电子版), 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.	宋达疆, 李赞, 周晓, 等. 带蒂股前外侧肌皮瓣修复腹壁肿瘤术后全层缺损. 中国修复重建外科杂志, 2019, 33(6): 712-716.
13.	赵民, 吴金英, 袁作雄, 等. 前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2019, 33(5): 586-589.
14.	晏晓青, 杨红岩, 由磊, 等. 应用腹壁下动脉穿支岛状皮瓣修复会阴部软组织缺损. 中国实用美容整形外科杂志, 2006, 17(1): 24-26.
15.	刘元波, 范金财, 焦鹏, 等. 腹壁下动脉穿支岛状皮瓣修复会阴部瘢痕挛缩. 中华整形外科杂志, 2008, 24(1): 79-80.
16.	程开祥, 刘阳, 沈国雄. 阴茎再造术的临床对比研究. 组织工程与重建外科杂志, 2005, 1(4): 232-233, 236.
17.	Ünverdi ÖF, Kemaloğlu CA. A reliable technique in the reconstruction of large penoscrotal defect: Internal pudendal artery perforator flap. Urology, 2019, 128: 102-106.

1. 吕梦竹, 郭澍, 唐明睿, 等. 会阴部缺损修复的方法及原则: 附一例病例报道及文献学习. 中国美容整形外科杂志, 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. 宋慧锋, 许明火, 高全文, 等. 会阴部亚单位缺损修复重建方案. 中华整形外科杂志, 2019, 35(5): 436-440.
5. 陈林海, 林光豪, 陈芝武, 等. 重建感觉的股前外侧穿支皮瓣修复会阴部 Paget 病根治术后软组织缺损的疗效分析. 中华整形外科杂志, 2019, 35(9): 907-912.
6. 谢昆, 温冰, 翟伟, 等. 穿支皮瓣在修复会阴区肿瘤术后缺损中的应用. 中华整形外科杂志, 2018, 34(9): 704-708.
7. 唐茂林, 杨大平, 梅劲, 等. 穿支皮瓣的解剖学及血流动力学研究进展. 中华显微外科杂志, 2016, 39(3): 312, 后插 1-后插 3.
8. 袁宇雯, 李海州, 顾斌, 等. 微泡增强多普勒超声技术在锁骨上动脉穿支皮瓣设计中的应用. 中华整形外科杂志, 2015, 31(1): 14-18.
9. 唐举玉, 魏在荣, 张世民, 等. 穿支皮瓣的临床应用原则专家共识. 中国临床解剖学杂志, 2016, 34(1): 4-5.
10. 王芳, 宋慧锋. 旋髂浅动脉穿支皮瓣的研究进展. 中华损伤与修复杂志 (电子版), 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. 宋达疆, 李赞, 周晓, 等. 带蒂股前外侧肌皮瓣修复腹壁肿瘤术后全层缺损. 中国修复重建外科杂志, 2019, 33(6): 712-716.
13. 赵民, 吴金英, 袁作雄, 等. 前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2019, 33(5): 586-589.
14. 晏晓青, 杨红岩, 由磊, 等. 应用腹壁下动脉穿支岛状皮瓣修复会阴部软组织缺损. 中国实用美容整形外科杂志, 2006, 17(1): 24-26.
15. 刘元波, 范金财, 焦鹏, 等. 腹壁下动脉穿支岛状皮瓣修复会阴部瘢痕挛缩. 中华整形外科杂志, 2008, 24(1): 79-80.
16. 程开祥, 刘阳, 沈国雄. 阴茎再造术的临床对比研究. 组织工程与重建外科杂志, 2005, 1(4): 232-233, 236.
17. Ünverdi ÖF, Kemaloğlu 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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