Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4349-4354
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4349
Reconstruction of massive skin avulsion of the scrota and penis by combined application of dermal regeneration template (Pelnac) and split-thickness skin graft with vacuum-assisted closure: A case report
Jia-Jie Fang, Peng-Fei Li, Jia-Jun Wu, Hai-Ying Zhou, Li-Ping Xie, Hui Lu
Jia-Jie Fang, Li-Ping Xie, Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Peng-Fei Li, Department of Plastic and Aesthetic Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Jia-Jun Wu, Xingyan Aesthetic Clinic, Hangzhou 310003, Zhejiang Province, China
Hai-Ying Zhou, Hui Lu, Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Fang JJ and Li PF contributed equally to this work; Xie LP and Lu H contributed equally to this work; Lu H, Xie LP, Li PF, Fang JJ, Wu JJ and Zhou HY designed the study; Lu H, Xie LP, Li PF and Fang JJ performed the surgeries and patient care; Wu JJ and Zhou HY contributed related research; Lu H, Xie LP analyzed the data; and Li PF and Fang JJ wrote the paper.
Supported by National Natural Science Foundation of China, No. 81702135; Zhejiang Traditional Chinese Medicine Research Program, No. 2016ZA124 and No. 2017ZB057; Zhejiang Medicine and Hygiene Research Program, No. 2016KYB101 and No. 2015KYA100; Zhejiang Medical Association Clinical Scientific Research Program, No. 2013ZYC-A19 and No. 2015ZYC-A12.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li-Ping Xie, MD, Chief Doctor, Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. xielp@zju.edu.cn
Telephone: +86-571-87236121
Received: June 10, 2019
Peer-review started: June 10, 2019
First decision: October 24, 2019
Revised: October 30, 2019
Accepted: November 14, 2019
Article in press: November 14, 2019
Published online: December 26, 2019
Processing time: 199 Days and 6.4 Hours
Abstract
BACKGROUND

Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.

CASE SUMMARY

A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.

CONCLUSION

Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuum-assisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.

Keywords: Artificial dermis; Dermal regeneration template; Massive skin defect; Penoscrotal defect; Split-thickness skin graft; Case report

Core tip: Skin avulsions of the scrotum and penis are rarely seen, especially massive avulsions. However, when they do occur, it is vital for surgeons to take prompt and judicious measures to repair the defects to avoid possible disabilities which could be both physically and psychologically traumatic. We report a case with massive skin avulsion of the scrota and penis, where we customized treatment by combining a dermal regeneration template (Pelnac) and a split-thickness skin graft to cover the defect with vacuum-assisted closure using three steps. Our experience with this wound repair proved that this combination is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.