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Thinned Pedicle Deep Inferior Epigastric Perforator (DIEP) Flap for Scrotal Reconstruction

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Abstract

The deep inferior epigastric artery perforator (DIEP) flap has been widely used for approximately 30 years as an effective method for breast reconstruction, defect repair, and perineal reconstruction. However, few literatures have reported on thinned pedicle DIEP flaps for scrotal reconstruction. The present study presents a series of reconstruction of the scrotum using thinned pedicle DIEP flaps. Five patients with large scrotal skin defects were admitted to our hospital from October 2010 to December 2015. Among these patients, three patients had testes and spermatic cord exposure after accidental injury, while two patients had testes exposure after machine extrusion. All of these patients were repaired using thinned pedicle DIEP flaps. During the 12–24-month follow up, one patient experienced a bulky flap, and a subsequent thinned flap was successfully made. The other four flaps were successfully transplanted with good esthetic and functional results. All donor sites were primarily closed; there was no functional disturbance, such as dysuria and abdominal hernia, and the sensation of these flaps partially recovered after 6 months. The thinned pedicle DIEP flap is robust, reliable, and resilient, and offers good-quality skin cover and cushion to the testes. This flap can be considered a good choice for scrotal reconstruction.

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References

  1. Young WA, Wright JK (1998) Scrotal reconstruction with a rectus abdominis muscle flap. Br J Plast Surg 41(2):190–193

    Article  CAS  Google Scholar 

  2. Dent BL, Dinesh A, Khan K, Engdahl R (2018) Scrotal reconstruction with integra following necrotizing fasciitis. J Emerg Trauma Shock 11(1):57–59. https://doi.org/10.4103/JETS.JETS_62_17

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lin CT, Chang SC, Chen SG, Tzeng YS (2016) Reconstruction of perineoscrotal defects in Fournier’s gangrene with pedicle anterolateral thigh perforator flap. ANZ J Surg 86(12):1052–1055. https://doi.org/10.1111/ans.12782

    Article  PubMed  Google Scholar 

  4. Scaglioni MF, Fakin RM, Barth AA, Giovanoli P (2017) Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene. Microsurgery 37(6):669–673. https://doi.org/10.1002/micr.30083

    Article  PubMed  Google Scholar 

  5. Hsu H, Lin CM, Sun TB, Cheng LF, Chien SH (2007) Unilateral gracilis myofasciocutaneous advancement flap for single stage reconstruction of scrotal and perineal defects. J Plast Reconstr Aesthet Surg 60(9):1055–1059. https://doi.org/10.1016/j.bjps.2006.09.005

    Article  PubMed  Google Scholar 

  6. Aydin T, Feyzi K, Tayfun T et al (2010) Reconstruction of wide scrotal defect using groin fasciocutaneous island flap combined with a strip of deep fascia. J Plast Reconstr Aesthet Surg 63(8):1394–1395. https://doi.org/10.1016/j.bjps.2010.01.006

    Article  PubMed  Google Scholar 

  7. Fang BR, Ameet H, Wang XC et al (2011) Pedicled thinned deep inferior epigastric artery perforator flap for perineal reconstruction: a preliminary report. J Plast Reconstr Aesthet Surg 64(12):1627–1634. https://doi.org/10.1016/j.bjps.2011.04.013

    Article  PubMed  Google Scholar 

  8. Guyuron B (2019) Discussion: multiplane forehead shortening: sparing the frontalis muscle and supraorbital nerve [J]. Plast Reconstr Surg 143(2):414–415. https://doi.org/10.1097/PRS.0000000000005272

    Article  CAS  PubMed  Google Scholar 

  9. Han HH, Lee JH, Kim SM, Jun YJ, Kim YJ (2016) Scrotal reconstruction using a superficial circumflex iliac artery perforator flap following Fournier’s gangrene. Int Wound J 13(5):996–999. https://doi.org/10.1111/iwj.12353

    Article  PubMed  Google Scholar 

  10. Netscher D, Marchi M, Wigoda P (1993) A method for optimizing skin graft healing and outcome of wounds of the penile shaft and scrotum. Ann Plast Surg 31(5):447–449

    Article  CAS  Google Scholar 

  11. Lee YJ, Park MC, Park DH, Hahn HM, Kim SM, Lee IJ (2017) Effectiveness of acellular dermal matrix on autologous split-thickness skin graft in treatment of deep tissue defect: esthetic subjective and objective evaluation. Aesthet Plast Surg 41(5):1049–1057. https://doi.org/10.1007/s00266-017-0891-2

    Article  Google Scholar 

  12. Ferreira PC, Reis JC, Amarante JM et al (2007) Fournier’s gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg 119(1):175–184. https://doi.org/10.1097/01.prs.0000244925.80290.57

    Article  CAS  PubMed  Google Scholar 

  13. Maharaj D, Naraynsingh V, Perry A, Ramdass M (2002) The scrotal reconstruction using the “Singapore sling”. Plast Reconstr Surg 110(1):203–205

    Article  Google Scholar 

  14. Datubo-Brown DD (1990) Alternative techniques for scrotal reconstruction. Br J Urol 65(1):115–117

    Article  CAS  Google Scholar 

  15. Mello DF, Helene Júnior A (2018) Scrotal reconstruction with superomedial fasciocutaneous thigh flap. Rev Col Bras Cir 45(1):e1389. https://doi.org/10.1590/0100-6991e-20181389

    Article  PubMed  Google Scholar 

  16. Kwon EO, Pareek G, Fracchia JA, Armenakas NA (2008) Scrotal reconstruction using rapid intraoperative tissue expansion: a preliminary report. J Urol 179(1):207–209. https://doi.org/10.1016/j.juro.2007.08.129

    Article  PubMed  Google Scholar 

  17. Atik B, Tan O, Ceylan K, Etlik O, Demir C (2006) Reconstruction of wide scrotal defect using superthin groin flap. Urology 68(2):419–422. https://doi.org/10.1016/j.urology.2006.04.003

    Article  PubMed  Google Scholar 

  18. Karsidag S, Akcal A, Sirvan SS, Guney S, Ugurlu K (2011) Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap. Microsurgery 31(2):116–121. https://doi.org/10.1002/micr.20839

    Article  PubMed  Google Scholar 

  19. Hallock GG (2006) Scrotal reconstruction following fournier gangrene using the medial circumflex femoral artery perforator flap. Ann Plast Surg 57(3):333–335. https://doi.org/10.1097/01.sap.0000218505.13232.1b

    Article  CAS  PubMed  Google Scholar 

  20. Lucas JW, Lester KM, Chen A et al (2017) Scrotal reconstruction and testicular prosthetics. Transl Androl Urol 6(4):710–721. https://doi.org/10.21037/tau.2017.07.06

    Article  PubMed  PubMed Central  Google Scholar 

  21. El-Sabbagh AH (2018) Coverage of the scrotum after Fournier's gangrene. GMS Interdiscip Plast Reconstr Surg DGPW 15(7):Doc01. https://doi.org/10.3205/iprs000121

    Article  Google Scholar 

  22. Mopuri N, O’Connor EF, Lwuagwu FC (2016) Scrotal reconstruction with modified pudendal thigh flaps. J Plast Reconstr Aesthet Surg 69(2):278–283. https://doi.org/10.1016/j.bjps.2015.10.039

    Article  PubMed  Google Scholar 

  23. Kayikçioğlu A (2003) A new technique in scrotal reconstruction: short gracilis flap. Urology 61(6):1254–1256. https://doi.org/10.1016/S0090-4295(03)00158-4

    Article  PubMed  Google Scholar 

  24. Wang D, Zheng H, Deng F (2003) Spermatogenesis after scrotal reconstruction. Br J Plast Surg 56(5):484–488. https://doi.org/10.1016/S0007-1226(03)00187-5

    Article  PubMed  Google Scholar 

  25. Wang D, Wei Z, Sun G et al (2009) Thin-trimming of the scrotal reconstruction flap: long-term follow-up shows reversal of spermatogenesis arrest. J Plast Reconstr Aesthet Surg 62(11):e455–e456. https://doi.org/10.1016/j.bjps.2008.06.014

    Article  CAS  PubMed  Google Scholar 

  26. Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42(6):645–648

    Article  CAS  Google Scholar 

  27. Hivelin M, Lantieri L (2018) Autologous breast reconstruction by deep inferior Epigastric free flap: classic and minimally invasive extraperitoneal approaches. Ann Chir Plast Esthet 63(5–6):457–472. https://doi.org/10.1016/j.anplas.2018.08.004

    Article  CAS  PubMed  Google Scholar 

  28. Wang X, Qiao Q, Burd A, Liu Z, Zhao R, Song K, Feng R, Zeng A, Zhao Y (2007) A new technique of vaginal reconstruction with the deep inferior epigastric perforator flap: a preliminary report. Plast Reconstr Surg 119(6):1785–1790. https://doi.org/10.1097/01.prs.0000259076.16918.fa

    Article  CAS  PubMed  Google Scholar 

  29. Zeng A, Xu J, Yan X, You L, Yang H (2006) Pedicled deep inferior epigastric perforator flap: an alternative method to repair groin and scrotal defects. Ann Plast Surg 57(3):285–288. https://doi.org/10.1097/01.sap.0000221466.97653.15

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank all of their colleagues at the Institute of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, for the full cooperation and support.

Funding

This study was supported by the National Natural Science Foundation of China (81571906).

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Author notes

  1. Baoqiang Song and Zhaoxiang Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 15 Changle Western Road, Xi’an, Shaanxi, 710032, People’s Republic of China

    Baoqiang Song, Zhaoxiang Zhang, Yang Li, Juan Zhang, Jiaomiao Pei & ZhangQiang Tuo

  2. MYFUN Medical Cosmetology Hospital, No. 21 Taoyuan South Road, Xi’an, Shaanxi, China

    Qing Liu

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  1. Baoqiang Song
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  2. Zhaoxiang Zhang
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Correspondence to Baoqiang Song.

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Song, B., Zhang, Z., Liu, Q. et al. Thinned Pedicle Deep Inferior Epigastric Perforator (DIEP) Flap for Scrotal Reconstruction. Indian J Surg 83, 61–65 (2021). https://doi.org/10.1007/s12262-020-02271-2

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  • DOI: https://doi.org/10.1007/s12262-020-02271-2

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