A combined protocol for improving reconstruction of scrotal skin avulsions: The experience of the University Hospital Center of Foggia

Objective: Scrotal degloving injuries are rare and constitute a challenge for reconstructive surgeons. The authors describe their successful experience with a combined reconstruction protocol using an acellular dermal matrix (ADM), negative pressure wound therapy (NPWT) and a split-thickness skin graft (STSG), and the retrospective assessment of overall morbidity and esthetic outcomes. Methods: Five consecutive patients underwent a wide excision of necrotic scrotal skin and a reconstruction procedure using a combined protocol with NPWT, Pelnac (R), and STSG. The efficacy of this treatment was determined by assessing overall morbidity and esthetic outcomes with the Vancouver Scar Scale (VSS). Results: The combined protocol made it possible to create an environment that promoted wound healing, improved graft intake, and gage the reconstructed site a more natural look. No significant problems were observed. Satisfactory cosmetic and functional results were obtained in all patients as shown by VSS scores obtained. Conclusions: We believe that this combined protocol is a reliable alternative to flaps and should be considered an excellent option in scrotal reconstruction, especially in critical patients.