阴囊坏疽皮肤缺损修复策略  

Repair strategies for skin defects due to scrotal gangrene

作　　者：杜震[1] 向鹏 陈山[1] 许莲姬[2] 张君毅[2] 马涛[2] 乔庐东[1] DU Zhen;XIANG Peng;CHEN Shan;XU Lianji;ZHANG Junyi;MA Tao;QIAO Ludong(Department of Urology,Beijing Tongren Hospital,Capital Medical University,Beijing,100176,China;Department of Plastic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100176,China)

机构地区：[1]首都医科大学附属北京同仁医院泌尿外科,北京100176 [2]首都医科大学附属北京同仁医院整形外科,北京100176

出　　处：《临床泌尿外科杂志》2025年第2期128-130,135,共4页Journal of Clinical Urology

摘　　要：目的:探讨阴囊坏疽所致皮肤局部缺损的分型及其修复策略。方法:回顾性分析2014年11月—2023年7月北京同仁医院泌尿外科收治的21例阴囊坏疽患者临床资料。患者均为男性,平均年龄(57.8±21.1)岁,平均发病时间(5.3±4.4)d。依据皮肤缺损范围进行分型,Ⅰ型:单纯阴囊皮肤缺损小于50%;Ⅱ型:单纯阴囊皮肤缺损大于50%;Ⅲ型:合并阴茎皮肤缺损;Ⅳ型:合并耻骨上皮肤缺损;Ⅴ型:合并肛周皮肤缺损。根据皮肤缺损的分型选择不同的修复方案。术后观察伤口、皮瓣愈合及并发症发生率。结果:21例患者,住院天数3~64 d,中位34 d;随访6~36个月,中位17个月。Ⅰ型16例,直接拉拢缝合。Ⅱ型2例,单侧睾丸切除后缝合。Ⅲ型2例,1例仅合并阴茎腹侧皮肤缺损,右侧阴部内动脉穿支皮瓣修复;1例合并阴茎全周皮肤缺损,阴囊创面单侧睾丸切除后缝合,右下肢局部带蒂皮瓣转移修复阴茎缺损。Ⅳ型1例,阴囊创面单侧睾丸切除后缝合,耻骨上局部皮瓣旋转修复耻骨上缺损。术后20例均恢复顺利,1例出现皮瓣远端局限性坏死,行清创术后一期缝合,术后恢复顺利。1例术后10 d出现单侧附睾炎,经抗感染治疗2周后治愈。结论:我们依据皮肤缺损范围的不同对阴囊坏疽所致皮肤缺损进行的分型,并根据分型选择不同的修复方案,在临床上操作方便、安全可行。Objective:To investigate the types and repair strategies for local skin defects caused by gangrene of scrotum.Methods:The clinical data of 21 patients with scrotal gangrene admitted to the Department of Urology,Beijing Tongren Hospital from November 2014 to July 2023 were retrospectively analyzed.All male patients'age were(57.8±21.1)years old,and the duration of onset were(5.3±4.4)days.Type Ⅰ:simple scrotal skin defect was less than 50%;type Ⅱ:simple scrotal skin defect was more than 50%;type Ⅲ:scrotal skin defect was complicated with penile skin defect;type Ⅳ:scrotal skin defect was complicated with suprapubic skin defect;type Ⅴ:scrotal skin defect was complicated with perianal skin defect.According to the type of skin defect,different repair schemes were selected.Wound and flap healing and complication rate were observed after operation.Results:Twenty-one patients were hospitalized for 3-64 days(median 34 days)and followed up for 6-36 months(median 17 months).Sixteen cases of typeⅠunderwent direct suture.Two cases of type Ⅱ were sutured after unilateral testicle resection.There were 2 cases of type Ⅲ.One case was only complicated with ventral skin defect,which was repaired by right internal pudendal artery perforator flap.In the other case,the defect of penis was repaired by unilateral testicle resection and local pedicled flap transfer of right lower extremity.In 1 case of type Ⅳ,the scrotal wound was resected and the suprapubic local flap was rotated to repair the suprapubic defect.All the 20 cases recovered successfully after operation.However,1 case had localized necrosis of the distal flap,and underwent one stage suture after debridement.One patient developed unilateral epididymitis 10 days after surgery and was cured after 2 weeks of anti-infection treatment.Conclusion:The classification of skin defects caused by scrotal gangrene according to the different scope of skin defects and the selection of different repair schemes according to the classification are convenient,safe and feasibl

关 键 词：阴囊坏疽 负压辅助愈合治疗系统 皮肤缺损 局部皮瓣 

分 类 号：R634[医药卫生—外科学]