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Archive for the ‘scrotoplasty’ Category

Case Study – Scrotal Reduction

Sunday, February 12th, 2017

 

Background: The normally quiescent scrotum that draws little attention can become a major focus when it dramatically enlarges. There are a variety of causes for scrotal enlargement including injury, genital and pubic mound surgery, inguinal hernias,  testicular torsion, varicoele, orchitis, hydrocoele and epididymitis to name the most common. In almost of of these causes once the source is properly treated and healing has occurred the scrotum will shrink back to normal. Acute scrotal edema almost always completely resolves.

Chronic scrotal edema/enlargement occurs from different sources. One of the common for refractory scrotal enlargement is lymphedema. If partial blockage occurs of the draining lymphatics or veins, the scrotum will remain edematous. There is no compression method to conservatively treat chronic scrotal lymphedema and make the scrotum smaller. Trying such compression may actually worsen the problem and may hinder the already limited blood supply to the scrotum. Further obstructing the venous outflow can increase the swelling. In addition the thin scrotal skin is not very tolerant of compression besides the obvious difficulty. Chronic scrotal enlargement can only be reduced by surgery.

Case Study: This 32 year-old male presented with chronic scrotal enlargement, being roughly 2X to 3X its normal size. He had a history of some form of autoimmune skin infection of the groin, believed to be a form of psoriasis. It eventually become improved through the use Humira and daily low-dose antibiotics. While not 100% cured, it was 98% improved. This skin condition left him with a chronically enlarged scrotum with thickened skin and diffuse subcutaneous tissue thickening. Besides its appearance, it gave him difficulty with wearing clothes and chaffing of the groin and scrotal skin.

testicular dissection in scrotal reduction Dr Barry Eppley IndianapolisScrotal Skin RemovalScrotal Reduction Surgery Dr Barry Eppley IndianapolisUnder general anesthesia and in a frog-legged position, a large elliptical excisional pattern was marked out vertically using the midline raphe as the center. The widest area of excision was 14 cms. The thickened skin and the watery expanded superficial fascial tissue were excised. The testicules and the enveloping tunica vaginalis lining were dissected out and preserved. Closure was done by covering the testicles with the remaining scrotal skin with a midline approximation.

A chronically enlarged scrotum can be effectively reduced by wide excision of the redundant tissues. The scar line should be placed along the naturally occurring midline raphe where a good scar outcome would be expected.

Highlights:

1) Permanent scrotal enlargement can occur from chronic skin infections that results in enlarged and abnormal skin

2) Scrotal reduction involves an elliptical excision of skin and fascia centered along the vertical midline raphe.

3) Scrotal reduction preserves the testicles and their surrounding sac.

Dr. Barry Eppley

Indianapolis, Indiana

Scrotoplasty – Scrotal Reduction and Lift

Monday, June 8th, 2015

 

The size of a male’s scrotum is rarely an aesthetic issue and is often paid given little attention. But as men age and particularly if they undergo a lot of weight loss their scrotum may get larger by virtue of the development of loose skin. Such scrotal enlargement can be more than a cosmetic concern but can cause skin irritation and discomfort in tight or athletic clothing.

A scrotal deformity can affect the size and symmetry of the sac alone or where it joins with the penis, most commonly seen as peno-scrotal webbing. Issues such as the amount of scrotal sac hanging or sag and asymmetry between the two scrotal halves are frequent aesthetic concerns. There is also the issue of the appearance of the scrotum during erection and sexual activity.

scrotal rapheScrotoplasty is a surgical procedure that reduces the scrotal skin sleeve but strives to maintain its normal shape at the same time. While the need for scrotal reduction/scrotal lift is not common, this does not make it any less significant to those men so affected. The best approach for scrotal skin reduction for sagging correction is a midline approach keeping the excision and the final skin closure along the vertical raphe between the scrotal halves. This is a natural and logical place for a scrotal skin scar.

The amount of midline scrotal skin removal is a matter of judgment and preoperative marking. But when closing the vertical excision site it is helpful to plicate the muscle layer (dartos fascia/muscle) to help reduce the tension on the overlying skin closure. This will also prevent postoperative skin stretching from the weight of the testicles.

Scrotoplasty with Pubic Lift Dr Barry Eppley IndianapolisAnother common scrotal deformity is that of peno-scrotal webbing.  Usually the junction of the base of the penis and the scrotum is not clearly demarcated. When a web of skin is present across this interface it can make the penis look short on its underside. This webbing can be due to a lack of adequate skin caused by congenital development, a prior aggressive circumcision as an infant or the creation of a pseudo web due to weight loss. Small webs can be lengthened by a direct z-plasty while large webs require a vertical excision of loose skin with a z-plasty placed directly over the peno-scrotal junction. In men who have undergone a lot of weight loss this can be combined with a pubic lift for an overall reshaping effect.

Scrotoplasty is a plastic surgery option for men who are bothered by scrotal sac deformities. A tightened and uplifted scrotum and/or a more defined peno-crotal junction can be surgically created.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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