Scrotal reconstruction by testicular apposition and wrap-around skin grafting

Scrotal loss with testicular exposure commonly follows debridement for necrotising infections and is devastating to the patient both physically and psychologically. This article describes our method of scrotal reconstruction by testicular apposition and wrap-around skin grafting. The key elements of our technique are: (1) preservation of viable spermatic fascia, (2) suturing the testes together with a broad surface area of contact to allow fusion of testicular fascial layers into a single scrotal sac and (3) meticulous attention to skin graft take. We applied this technique in 27 consecutive patients. Two-thirds (66%) achieved thin, pliable scrotums that closely mimicked an original scrotum while 18% developed well-formed sacs with slight adhesions. This technique is simple, reproducible and achieves for the patient an aesthetic neoscrotum with minimal morbidity.