Scrotal Trauma and Reconstruction

Scrotal Trauma and Reconstruction



The anatomy of the male genitalia is quite complex. In the scrotum, there are multiple fascial layers (Figs. 63.1 and 63.2). From the standpoint of trauma, however, most of the fascial layers are relatively unimportant. The Buck fascia is related to the deep penile structures and is important in the containment of periurethral processes or the occasional hematoma associated with injury to the corpora cavernosa and/or corpus spongiosum. In the scrotum, the analogous fascia to the Buck fascia—the external spermatic fascia—is usually uninvolved with scrotal trauma (see Fig. 63.2).

Culp (1) has classified injuries to the external male genitalia into five categories: nonpenetrating, penetrating, avulsions, burns, and radiation injuries (both direct and indirect). Nonpenetrating injuries result from either a crushing or sudden deforming force to the scrotum. These forces can cause severe damage to the internal structures without disrupting the skin. With any nonpenetrating trauma to the scrotum or perineum, one must suspect and rule-out injury to the corpus spongiosum and urethra.

FIGURE 63.1 A: Cross section of the penis illustrating the fascial and structural components of the shaft of the penis. B: Sagittal section of the pelvis demonstrating the fascial layers and structural component.


Exploration of the scrotum is indicated if the patient has sustained either blunt or penetrating injury to the testicle (LOE 3) (2). Scrotal reconstruction is required following complex lacerations and avulsion injuries. If a patient has required excision for chronic cellulitis, lymphangiectasia, and lymphedema, STSG reconstruction of the scrotum is very effective and provides cosmetically very acceptable results. Meshing STSGs used for scrotal reconstruction allows for increased coverage, drainage of potential hematoma, and seroma accumulations, and the meshed graft mimics the natural rugae of the scrotum after it has healed. If the lymphedematous process is due to a local process, often the lateral scrotum and the posterior scrotum are spared from disease and uninvolved because the posterior scrotum is drained by the perirectal lymphatics. In these cases, lateral scrotal flap reconstruction is often very effectively employed.

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Apr 24, 2020 | Posted by in UROLOGY | Comments Off on Scrotal Trauma and Reconstruction

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