European Journal of Plastic Surgery

, Volume 36, Issue 7, pp 399–406 | Cite as

Scrotal reconstruction: a review and a proposed algorithm

  • Qadir Khan
  • Robert John William Knight
  • Anna Goodwin-Walters


Scrotal reconstruction is a difficult problem following infection, trauma or tumour resection. The focus of classic reconstructive options remains occlusive and aesthetic with little regard for testicular function. The important factors in choosing the right reconstructive option for our patients are age, testicular functional requirements and best aesthetic outcome. We reviewed contemporary options available for reconstruction of the scrotum and their effects on testicular function in an effort to provide an algorithm for scrotal reconstruction. We performed an extensive online search using OVID SP, OVID, Medline, PubMed, CINAHL Plus and Cochrane Library database using keywords “scrotal, scrotum and reconstruction”. The introduction of axial pattern analysis of flaps has led to a flourish of innovative and novel coverage techniques to achieve aesthetic and gross reproductive function. With the emergence of new technology, however, spermatogenesis has moved to the forefront of the field, and a new paradigm shift in reconstruction needs to follow. New studies have re-orientated best practice to include this in the reconstructive ladder, and here, we provide a useful algorithm for scrotal reconstitution that will help reconstructive surgeons in choosing the right option for their patients.


Scrotal Scrotum Scrotal reconstruction Fournier's gangrene 


Conflict of Interest



  1. 1.
    Chen SY, Fu JP, Chen TM et al (2011) Reconstruction of scrotal and perineal defects in Fournier's gangrene. J Plastic Reconstr Aesthet Surg 64(4):528–534CrossRefGoogle Scholar
  2. 2.
    Ferreira PC, Reis JC, Amarante JM et al (2007) Fournier's gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg 119(1):175–184PubMedCrossRefGoogle Scholar
  3. 3.
    Tan BK, Rasheed MZ, Wu WT (2011) Scrotal reconstruction by testicular apposition and wrap-around skin grafting. J Plastic Reconstr Aesthet Surg 64(7):944–948CrossRefGoogle Scholar
  4. 4.
    Bothra R, Bhat A, Saxena G et al (2011) Dog bite injuries of genitalia in male infant and children. Urol Ann 3(3):167–169PubMedCrossRefGoogle Scholar
  5. 5.
    Selvan S, Alagu G, Gunasekaran R (2009) Use of a hypogastric flap and split-thickness skin grafting for a degloving injury of the penis and scrotum: a different approach. Indian J Plast Surg 42(2):258–260PubMedCrossRefGoogle Scholar
  6. 6.
    Balakrishnan C (1956) Scrotal avulsion: a new technique of reconstruction by split-skin graft. Br J Plast Surg 9(1):38–42PubMedCrossRefGoogle Scholar
  7. 7.
    Jacobs FM, Berry JL (1946) Reconstruction of the scrotum; a new use for the prepuce. J Urol 61(5):956–959Google Scholar
  8. 8.
    Cuccia G, Mucciardi G, Morgia G et al (2009) Vacuum-assisted closure for the treatment of Fournier's gangrene. Urol Int 82(4):426–431PubMedCrossRefGoogle Scholar
  9. 9.
    Weinfeld AB, Kelley P, Yuksel E et al (2005) Circumferential negative-pressure dressing (VAC) to bolster skin grafts in the reconstruction of the penile shaft and scrotum. Ann Plast Surg 54(2):178–183PubMedCrossRefGoogle Scholar
  10. 10.
    Taglialatela Scafati S, Lalinde Carrasco E (2011) Microsurgically thinned groin flap for partial scrotal reconstruction. J Plast Reconstr Aesthet Surg 65(5):690–691PubMedCrossRefGoogle Scholar
  11. 11.
    Karsidag S, Akcal A, Sirvan SS et al (2011) Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap. Microsurgery 31(2):116–121PubMedCrossRefGoogle Scholar
  12. 12.
    Coskunfirat OK, Uslu A, Cinpolat A et al (2011) Superiority of medial circumflex femoral artery perforator flap in scrotal reconstruction. Ann Plast Surg 67(5):526–530PubMedCrossRefGoogle Scholar
  13. 13.
    Dali W, Hong Z, Fei D (2003) Spermatogenesis after scrotal reconstruction. Br J Plast Surg 56(5):484–488CrossRefGoogle Scholar
  14. 14.
    Demir Y, Aktepe F, Kandal S et al (2011) The effect of scrotal reconstruction with skin flaps and skin grafts on testicular function. Ann Plast Surg 68(3):308–313CrossRefGoogle Scholar
  15. 15.
    Spyriounis P (2009) Scrotum reconstruction with the anterolateral (ALT) thigh flap. Eur J Plast Surg 32(3):123–126CrossRefGoogle Scholar
  16. 16.
    Sun G, Wang D, Wei Z et al (2011) Effect of scrotal reconstruction with free skin graft on spermatogenesis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 25(11):1357–1359PubMedGoogle Scholar
  17. 17.
    Maloney S, Shepherd K, Bakker A (2005) Contractile physiology and response to temperature changes of the tunica dartos muscle of the rat. Eur J Physiol 451:489–497CrossRefGoogle Scholar
  18. 18.
    Shafik A (1973) The dartos muscle. A study of its surgical anatomy and role in varicocelogenesis: a new concept of its thermoregulatory function. Invest Urol 11:98–100PubMedGoogle Scholar
  19. 19.
    Kanter M, Aktas C (2009) Effects of scrotal hyperthermia on Leydig cells in long-term: a histological, immunohistochemical and ultrastructural study in rats. J Mol Histol 40:123–130PubMedCrossRefGoogle Scholar
  20. 20.
    Rapp D, Cohn A, Gottlieb L et al (2005) Use of tissue expansion for scrotal sac reconstruction after scrotal skin loss. Urology 65(6):1216–1218PubMedCrossRefGoogle Scholar
  21. 21.
    Chadha A, Saraiya H (1991) Scrotal reconstruction using Foley catheters as tissue expanders. Ann Plast Surg 26(3):291–292PubMedCrossRefGoogle Scholar
  22. 22.
    Kwon E, Pareek G, Fracchia J et al (2008) Scrotal reconstruction using rapid intraoperative tissue expansion: a preliminary report. J Urol 179(1):207–209PubMedCrossRefGoogle Scholar
  23. 23.
    Carrera A, Gil-Vernet A, Forcada P et al (2009) Arteries of the scrotum: a microvascular study and its application to urethral reconstruction with scrotal flaps. BJU Int 103(6):820–824PubMedCrossRefGoogle Scholar
  24. 24.
    Datubo-Brown D (1990) Alternative techniques for scrotal reconstruction. Br J Urol 65(1):115–117PubMedCrossRefGoogle Scholar
  25. 25.
    Gudaviciene D, Milonas D (2008) Scrotal reconstruction using thigh pedicle flaps after scrotal skin avulsion. Urol Int 81(1):121–124CrossRefGoogle Scholar
  26. 26.
    Maharaj D, Naraynsingh V, Perry A et al (2002) The scrotal reconstruction using the “Singapore sling”. Plast Reconstr Surg 110(1):203–205PubMedCrossRefGoogle Scholar
  27. 27.
    Payne C, Williams A, Hart N (2009) Lotus petal flaps for scrotal reconstruction combined with Integra resurfacing of the penis and anterior abdominal wall following necrotising fasciitis. J Plast Reconstr Aesthet Surg 62(3):393–397PubMedCrossRefGoogle Scholar
  28. 28.
    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):1394–1395PubMedCrossRefGoogle Scholar
  29. 29.
    Karacal N, Livaoglu M, Kutlu N et al (2007) Scrotum reconstruction with neurovascular pedicled pudendal thigh flaps. Urology 70(1):170–172PubMedCrossRefGoogle Scholar
  30. 30.
    Kayikcioqlu A (2003) A new technique in scrotal reconstruction: short gracilis flap. Urology 61(6):1254–1256CrossRefGoogle Scholar
  31. 31.
    Maguina P, Paulius K, Kale S et al (2010) Medial thigh fasciocutaneous flaps for reconstruction of the scrotum following Fournier gangrene. Plast Reconstr Surg 125(1):28e–30ePubMedCrossRefGoogle Scholar
  32. 32.
    Monteiro E, Carvalho P, Costa P et al (2002) “Inner thigh lift flap” for Fournier gangrene of the scrotum. Plast Reconstr Surg 110(5):1372–1373PubMedCrossRefGoogle Scholar
  33. 33.
    Sun GF, Wang DL, Li L et al (2010) Apoptosis of spermatogenic cells and expression of HSP70 after scrotal reconstruction with skin flap. Zhonghua Nan Ke Xue 16(7):606–610PubMedGoogle Scholar
  34. 34.
    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):455–456CrossRefGoogle Scholar
  35. 35.
    Hallock G (1990) Scrotal reconstruction following Fournier's gangrene using the medial thigh fasciocutaneous flap. Ann Plast Surg 24(1):86–90PubMedCrossRefGoogle Scholar
  36. 36.
    Hsu H, Lin C, Sun T et al (2007) Unilateral gracilis myofasciocutaneous advancement flap for single stage reconstruction of scrotal and perineal defects. J Plast Reconstr Aesthet Surg 60(9):1055–1059PubMedCrossRefGoogle Scholar
  37. 37.
    Noack N, Spierer R (2009) Uni- and bilateral pedicled muscular gracilis flaps for reconstruction of the scrotum in Fournier's gangrene. Handchir Mikrochir Plast Chir 41(4):248–251PubMedCrossRefGoogle Scholar
  38. 38.
    Kamei Y, Aoyama H, Yokoo K et al (1994) Composite gastric seromuscular and omental pedicle flap for urethral and scrotal reconstruction after Fournier's gangrene. Ann Plast Surg 33(5):565–568PubMedCrossRefGoogle Scholar
  39. 39.
    Isken T, Alagoz S, Unal C et al (2009) A new technique for reconstruction of the avulsed scrotum: the 3D- prefabricated omental flap. J Plast Reconstr Aesthet Surg 62(3):410–412PubMedCrossRefGoogle Scholar
  40. 40.
    Ng D, Tang C, Kadirkamanathan S et al (2010) Scrotal reconstruction with a free greater omental flap: a case report. Microsurgery 30(5):410–413PubMedGoogle Scholar
  41. 41.
    Kochakarn W, Hotrapawanond P (2001) Scrotal reconstruction using thigh pedicle flaps: long-term follow-up of 12 cases. J Med Assoc Thai 84(12):1738–1742PubMedGoogle Scholar
  42. 42.
    Mandel MA (1980) “Hiawatha” scrotal reconstruction. Ann Plast Surg 4(3):238–242PubMedGoogle Scholar
  43. 43.
    Millard DR Jr (1966) Scrotal construction and reconstruction. Plast Reconstr Surg 38(1):10–15PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Qadir Khan
    • 1
  • Robert John William Knight
    • 1
  • Anna Goodwin-Walters
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryRoyal Perth HospitalPerthAustralia

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