Complex Penile Keloid Excision With Bipedicle Scrotal Skin Flap Reconstruction

R. Vasdev, E. Olive, G. Ungerer, W. Gutierrez, B. Findlay, J. N.Warner

Reconstructive Penile Surgery, Pedicled Flap, Keloid

Bilateral pedicled scrotal flaps and free full thickness skin grafts have been previously used for complex penile skin reconstruction. However, bisection of scrotal flaps can risk tissue devascularization and increase total suture line burden. Herein, we describe our method of a bipedicle scrotal flap without midline bisection for complex keloid penile excision and reconstruction with intraoperative use of SPY Fluorescence Imaging. The patient was a 49-year-old male with a complex penile keloid following a kick to the groin by a horse. He reports pain with erections and penetrative sex. Pre-operative penile ultrasound confirmed adequate distal penile perfusion. MRI demonstrated a complex circumferential soft tissue mass sparing the corporal cavernosa and spongiosum. He underwent penile lesion excision and bilateral pedicled scrotal flap reconstruction as entailed in the surgical video. Interoperative SPY technology was used to verify adequate flap perfusion. The immediate perioperative period was unremarkable. Follow up at 6- and 12-weeks post-op demonstrated well healing incisions and intact erectile function without pain. Bipedicle scrotal flap without midline scrotal incisions is a valid means for complex penile reconstruction. Advantages of this technique include non-transection of the lateral margins to maintain scrotal skin blood supply and minimize suture lines.

None.

The authors have nothing to disclose