Arteries of the scrotum: a microvascular study and its application to urethral reconstruction with scrotal flaps

Abstract

OBJECTIVE To study scrotal microvascularization and apply the findings to the design of reliable skin flaps for reconstructive surgery of complex urethral or panurethral stenoses. MATERIALS AND METHODS In 15 cryopreserved male cadavers, scrotal skin vascularization was explored using macro‐ and microdissections, and the scrotal sac made transparent using the Spalteholtz method. A meticulous descriptive analysis of the arterial network was conducted out in all cases to evaluate the number, distribution and anastomosis of the cutaneous arteries of the scrotum. RESULTS Scrotal skin is irrigated by two main vascular systems, through the inferior external pudendal arteries and the perineal arteries, which branch into multiple scrotal arteries. These arteries are distributed in three cutaneous territories, two lateral and one central, which are widely inter‐anastomosed. Each lateral territory receives an inferior external pudendal artery which accesses at the midpoint of the scrotal root and fans out to cover the entire corresponding hemiscrotum. The central cutaneous territory is vascularized through the branches of two main scrotal arteries which are a continuation of the perineal arteries and which access via the posterior face, running deeply on both sides of the septum. CONCLUSIONS The special anatomical distribution of scrotal branches stemming from perineal arteries enables the construction of adequate reliable longitudinal median island scrotal flaps for the reconstructive surgery of panurethral stenosis, as profuse axial vascularization is ensured.

Two-Stage Pediatric Penile Reconstruction after Postcircumcision Gangrene

“…First, the scrotal skin well tolerates contact with urine owing to the abundance of sebaceous glands; second, the flap has abundant double vascularity without liability to torsion or stretching; and third, anatomical contiguity, and tissue availability of the flap. [18][19][20][21] Pediatric penile reconstruction should be fourth dimensional; taking future needs in consideration. Presence of penile sensation is crucial in adults, so it should be kept in mind while planning penile reconstruction in a child.…”

Scrotal-Septal Fasciocutaneous Flap Used as a Multifunctional Coverage for Prior Failed Hypospadias Repair

“…The anterior artery supplies the upper two-thirds of the skin tissue of scrotal septal skin flap, and the posterior scrotal arteries supplies the lower one-third of the scrotal septal skin flap. These vessels have branches that join together [9]. Moreover, the flap has great tissue volume and can be harvested without scrotum disfiguration.…”

Perineum-based Pediculated Scrotal Flap for Reconstructive Urethral Surgery

“…Scrota1 skin, dartos, external spermatic fascia, cremasteric fibers and fascia, internal spermatic fascia, and the scrotal septum are included in the flap; however, the tunica vaginalis is excluded [6]. …”