Peno-scrotal soft tissue loss: a need for multidisciplinary and multimodal integration

Aim: Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon. The non-availability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substances make the issue of reconstruction complicated. The authors present their experience with penoscrotal soft tissue loss with hyperbaric oxygen therapy as an adjunct. Methods: This retrospective study was undertaken in the department of plastic surgery, over a period of 2 years. Nine patients with scrotal or penile injury and infection were enrolled in the study. Age of the patients ranged 20-60 years. Five patients had traumatic loss of scrotal skin and 4 resulted following necrotizing soft tissue infection. All patients underwent hyperbaric oxygen therapy before and following surgery. Results: Healing was complete in all patients with minor complications as partial skin graft loss in 2 patients. Five patients (55.5%) had sustained the soft tissue loss due to trauma. The cause of necrotizing fasciitis was found in 4 patients (44.4%). The mean length of hospital stay was 42.5 days. Conclusion: Management of soft tissue loss of penoscrotal region requires an organized approach and the utilization of newer modalities for early recovery of these injuries is of primary need. Operating surgeons should know the various reconstructive pathways and use of adjunct measures like hyperbaric therapy for early recovery. Keywords: Scrotal soft tissue loss; necrotizing fasciitis; soft tissue reconstruction; hyperbaric oxygen therapy Scrotal soft tissue loss is one of the perplexing conditions for plastic surgeon. The non-availability of adequate nearby healthy soft tissue and its probability of recurrent faecal and urinary contamination make the issue of reconstruction complicated. All necessary effort to decrease the time period of healing of scrotal wounds should be undertaken as the condition may increase the morbidity following these injuries. Most of these patients suffer multiple co-morbidities and are immune-compromised adding to the complication of such conditions. We present our experience with penoscrotal soft tissue loss with hyperbaric oxygen therapy as an adjunct. This retrospective study was undertaken in the department of plastic surgery, over a period of 2 years from January 2012 to December 2014. The records of patients who underwent scrotal reconstruction were reviewed. Nine patients with scrotal or penile injury and infection were enrolled in the study. Informed written consent was obtained from all the patients enrolled in the study. Age of the patients ranged 20-60 years. Five patients had traumatic loss of scrotal skin and 4 resulted following necrotizing soft tissue infection. No patient had injuries or infection to urethra. Patients with necrotizing soft tissue infection of the scrotum were diabetic. Rest of the patients did not have any comorbidity. All patients underwent hyperbaric oxygen therapy before and following surgery. Patient requiring intensive care unit admission was excluded from our study, as we are not equipped with hyperbaric oxygen therapy settings in critically ill patients