Split-thickness skin grafting combined with a multi-anchor fixation technique for reconstruction of massive scrotal and penile skin avulsion: A case report.

Abstract

Isolated traumatic avulsion of the male external genitalia is a rare and surgically challenging. Reconstruction must restore both aesthetic and function, particularly given the substantial dimensional changes of penile skin during erection. To minimize long-term functional impairment and psychological morbidity, reconstruction should aim to restore normal anatomy and physiological compliance. The present study reported a case of massive left testicular, scrotal and penile skin avulsion, successfully managed using a split-thickness skin graft in combination with a novel multi-anchor fixation technique, resulting in optimal functional and cosmetic outcomes. A 39-year-old man sustained a severe perineal crush-avulsion injury after accidental entanglement in a conveyor belt. The injury resulted in complete avulsion of the penile skin, extensive scrotal skin loss, complete avulsion of the left testis and epididymis and exposure of the right testis, accompanied by active bleeding. The avulsed tissues were markedly fragmented and contaminated with machine oil. After thorough debridement of non-viable tissue, reconstruction was performed using a split-thickness skin graft harvested from the right anterolateral thigh. A novel multi-anchor fixation technique was used to secure the graft to key anatomical points on the tunica albuginea, thereby preventing graft redundancy, displacement and adhesion while preserving physiological compliance during erection. Follow-up at 6-12 months demonstrated complete wound healing, preserved penile morphology, normal erectile function and satisfactory sexual performance. In conclusion, split-thickness skin grafting combined with multi-anchor fixation can provide reliable coverage and restore penile morphology and function after severe penoscrotal degloving injury. This technique may be a useful reconstructive option for selected patients with extensive penile skin avulsion.