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

Abstract

BACKGROUNDAlthough 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 SUMMARYA 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.CONCLUSIONOur 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.

Utility of a New Artificial Dermis as a Successful Tool in Face and Scalp Reconstruction for Skin Cancer: Analysis of the Efficacy, Safety, and Aesthetic Outcomes

“…From the first studies of Suzuki on the possible applications of the new substitute [21], several authors produced about a dozen publications on its use, generally posttrauma [22][23][24][25][26][27][28], or for the correction of burn scars [29][30][31], or postremoval of giant nevi [32,33], or for ulcers repair [34,35].…”

Traumatic Degloving Injury of Penile and Scrotal Skin: A Case Report

“…A sponge immobilized the penile shaft in the erect position, as described by Li et al 10 This helped reduce contracture formation and enhanced the success of the graft. Another method has been previously mentioned in the literature by Fang et al 11 ; they managed a similar case of a massive traumatic penile and scrotal skin avulsion by combining split-thickness skin graft and dermal regeneration template with negative pressure wound therapy, which resulted in a satisfying outcome. In this report, the use of a split-thickness skin graft to cover the skin defects of traumatic penoscrotal degloving injuries demonstrated promising results cosmetically and functionally.…”

Pediatric penoscrotal degloving injury by a cordless drill: A case report and literature review

“…Split thickness skin graft is a simple procedure in which the graft can be harvested easily and can easily survive [13]. Full thickness skin graft is superior than split thickness skin graft both in functional and aesthetic value [4].…”

“…These will reduce the potential for shortening or phimosis and painful erections [4]. Nevertheless, the difficulty to harvest graft with less chance of graft survival are the biggest drawback of full thickness skin graft [4,13].…”

“…Scrotal flap has the same skin color and quality as the real penile skin and provide a stable and flexible skin enabling it to withstand erection and friction as per original penile skin with no risk of contracture [11,13].…”