Cobertura con colgajo escrotal en desforramiento peneano. A propósito de dos casos

Abstract

RESUMENRestablecer la cobertura cutánea en lesiones de urgencia es un desafío para el cirujano, más aún si se trata del pene, ya sea por desforramiento accidental o secundario a procesos sépticos de la región perineal. Se presentan 2 casos. El primero por lesión accidental en un menor de 9 años, quien pierde la totalidad de la piel peneana. El segundo caso en un paciente de 65 años, diabético e hipertenso que presentó un episodio de fasceítis necrotizante. En ambos casos se realiza una cobertura cutánea del defecto utilizando 2 colgajos fasciocutáneos de las bolsas escrotales. En el caso del niño, el defecto de cobertura creado en éstas se cubre con colgajo fasciocutáneo de la cara anterior del muslo, y éste último con un injerto dermoepidérmico de la extremidad contralateral, utilizando la misma técnica descrita para el menor. La técnica utilizada cumplió plenamente con los objetivos de realizar una cobertura adecuada, semejante a la piel original, sin interferir con el desarrollo sexual normal del menor y minimizando el trauma psicológico. En el paciente adulto los resultados funcionales y estéticos son adecuados. En la literatura revisada hay muy pocos casos clínicos con utilización de ésta técnica.PALABRAS CLAVE: Desforramiento peneano, cobertura cutánea, colgajo escrotal. ABSTRACTTo restore the cutaneous coverage in urgency injuries is a challenge for the surgeon, even more if it is a question of cutaneous coverage of the penis, by accidental degloving or secondary to septic processes of perineal region. We present two cases. The first one is a 9 years old minor, who lost the totality of his penis skin by accidental injury. The second case is a diabetic and hypertense, 65 years old patient, who had an * Recibido el 5 de Octubre de 2007 y aceptado para publicación el 8 de Noviembre de 2007.

Posoncological Cutaneous Reconstruction of Penis with Scrotum Flaps about a Case

“…The diagnosis is established by biopsy by puncture or excision. CT and MRI are useful in staging [5]. Classification for staging is done through the TNM system, and then grouped in stages of 0, I, II, III, or IV.…”

“…Classification for staging is done through the TNM system, and then grouped in stages of 0, I, II, III, or IV. Regarding treatment in Ta-1, G1-2: if the patient is susceptible to good follow-up, local excision is performed plus reconstructive surgery, Mohs surgery, brachytherapy and / or radiotherapy, laser excision Nd-YAG, cryotherapy, photodynamic therapy [5].…”

“…; Fax: ??????????? ; E-mail: hpzile@hotmail.com T1, G3 and T2 or greater lesions: partial or total penectomy is indicated, although conservative treatment could be used in well-selected patients (condition of less than half the glans and susceptible to good follow-up) In relapses after conservative treatment, treatment can be repeated if there is no invasion of the corpora cavernosa, but if there is, it is recommended total phalectomy [5].…”

“…Therapeutic lymphadenectomy is performed in patients with metastatic nodes, however, routine prophylactic lymphadenectomy is not indicated, because the morbidity of the procedure is 30% to 50%. If the nodes are not palpable, they are low risk: (pTis, pTa, G1-2, pT1, G1) undergo surveillance because the risk of lymph node metastasis is less than 16.5% [5].…”

“…Relapses usually occur in the first 2 years. When partial or total phalectomy was used, it occurs in 0% to 7%, but with treatment Conservative rises to 50% [5]. Cutaneous reconstruction of the penis remains one of the biggest challenges of surgery due to the inherent complexity of getting both the anatomical shape as the aesthetics of the penis [6].…”