Tissue Expander Scrotal Reconstruction.
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2020-03-24
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Abstract
Fournier's gangrene is a life-threatening soft tissue infection requiring aggressive debridement of the perineum. Surgical debridement results in large defects of the scrotum requiring reconstruction for functional coverage of the testes. Several studies have described scrotal reconstruction utilizing split thickness skin grafts or local flaps. These procedures create additional morbidity in an unhealthy patient population. This report describes a patient who presents for delayed scrotal reconstruction utilizing tissue expansion. Tissue expander-based reconstruction provides reconstruction of native scrotal soft tissue without additional donor site morbidity. A 40-year-old man presented to an outside hospital with Fournier's gangrene and underwent significant soft tissue debridement. He had an almost complete loss of his native scrotum with his testes surgically banked in his bilateral thighs. He presented to our clinic for a delayed scrotoplasty. The patient was taken to the operating room and a single tissue expander was inserted into the perineum. He underwent serial insufflations in the clinic setting and returned to the operating room for expander removal and scrotal reconstruction. The patient followed up in clinic 4 months postoperatively with a well-healed scrotoplasty. Our case report demonstrates a 2-stage procedure for patients presenting with significant soft tissue loss of the perineum. This reproducible method of reconstruction can be considered for excellent aesthetic and functional scrotoplasty.
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Hollins, Andrew, Lily R Mundy, Andrew Atia, Heather Levites, Andrew Peterson and Detlev Erdmann (2020). Tissue Expander Scrotal Reconstruction. Plastic and Reconstructive Surgery Global Open, 8(3). p. e2714. 10.1097/gox.0000000000002714 Retrieved from https://hdl.handle.net/10161/21167.
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Andrew N Atia
Andrew Charles Peterson
Dr. Peterson received his medical degree from Dartmouth Medical School in 1995 and completed his urology residency at Madigan Army Medical Center in 2002. He subsequently completed an advanced fellowship in Reconstructive Urology at Duke University in 2003. He then returned to Madigan Army Medical Center where he served as the Chief of Reconstructive Urology and the director of the urology residency.
Dr. Peterson joined the faculty at Duke in 2010 and currently serves as the Vice Chair for Education, the Urology Residency Program Director and directs the “Reconstructive Urology and Genitourinary Cancer Survivorship Fellowship”.
His research interests include improving the care of cancer survivors and the prevention of genitourinary side effects from various medical, surgical and radiation therapies for cancer. His clinical interests include reconstructive urology and bladder dysfunction in men and women; urinary incontinence in men; reconstruction for urethral stricture and trauma; new bladder construction and urinary diversion; video urodynamic study with particular value to patients with bladder-emptying problems and bladder-outlet symptoms; care of prostate cancer survivors with respect to sexual function and urinary continence, and urethral stricture disease after treatment with surgery or radiation. He is specifically skilled in the multidisciplinary management of complex genitourinary problems including scar tissue (bladder neck contracture, ureteral stricture), fistulas, radiation cystitis, and voiding dysfunction often seen in survivors of genitourinary cancers. He offers advanced surgical care including urethroplasty, placement of the artificial urinary sphincter (AUS), penile prosthesis, male sling, repair of recto-urethral fistula, and ureteral reimplantation for stricture.
During his 23 years in the United States Army Dr. Peterson achieved the rank of Colonel retiring from the Army Reserves in 2014. He is a graduate of the Command and General Staff College, and has been awarded the Expert Field Medical Badge, the Meritorious Service Medal with 3 oak leaf clusters, and the Bronze Star. He currently serves on the review panel of multiple peer reviewed journals. He is an active member of the Society for Genitourinary Reconstructive Surgeons and the Society for Government Service Urologists as well as the American Urological Association.
Detlev Erdmann
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