British Journal of Plastic Surgery (Ig77), 30, 86-87
DECUBITUS ULCER IN THE GROIN: REPAIR USING A TESTICULOSCROTAL FLAP By E. TAUBE, H. LABANDTERandI. KAPLAN Department of Plastic and Maxillo-Facial Surgery, Beilinson Medical Center, Petah Tiqva, Israel
A 24-YEAR-OLD MAN had been injured in a car accident 5 years before with damage to the spinal cord at D7-8 level; since then he is paraplegic. During the last 3 years he has suffered from recurrent decubitus ulcers which were treated elsewhere. On admission to our ward he had a deep ulcer, measuring IO x 12 cm in the right groin (Fig. I). In addition he had multiple smaller ulcers all around his pelvis: over the sacral area, left and right trochanteric areas and both ischial areas. Following correction of his anaemia and hypoalbuminaemia he was operated on.
FIG. I. Preoperative
view of sore in right groin.
After debridement it became apparent that the ulcer was extremly large. Laterally the cavity abutted on the femoral vessels, distally almost to the adductor canal. The pubic ramus was involved, the cavity extending behind the penile shaft. An adductor muscle flap was rotated from its proximal insertion to cover the femoral vessels. Following this procedure, a large medial cavity remained which we felt could not be adequately covered with a skin flap alone. A rotation flap of the scrotum was used, bringing the right testicle into the defect to fill the dead space (Fig. 2). Suction drainage was continued for a week. A large amount of sterile fluid, probably lymph, was discharged via the drain, 86
DECUBITUS
FIG. 2.
ULCER
IN
THE
GROIN
87
A large scrotal flap and the right testicle rotated into the defect. FIG. 3. Healed result 14 days postoperatively.
but after its removal the discharge ceased and the patient is now fit to undergo closure of his other sores (Fig. 3). DISCUSSION
In a series of 1,000 paraplegic cases described by Conway and Griffith (1956) no decubitus ulcers in the groin are mentioned, and we believe this is the first published case. The mechanism of development is not quite understood. We surmise that prolonged pressure of a urine bottle over the anaesthetic region was largely contributory. A scrotal Aap to repair an ischial decubitus ulcer was described by Kaplan (1972). The versatility of the scrotal flap has now been established having been used in sores of the ischium, pubis (Lanier and Neale, 1974) and now the inguinal area. In this case the testicle was also used as a space filler. REFERENCES CONWAY,H. and GRIFFITH, B. H. (1956). Plastic surgery for closure of decubitus ulcers in patients with paraplegia: based on experience with IOOOcases. American Journal of Surgery, 91,946.
of Plastic Surgery,
The scrotal flap in is&al
KAPLAN, I. (1976).
The scrotal flap repair for ischial decubitus ulcers: a follow-up.
q,22.
Journal
of Plastic Surgery,
29, 34.
decubitus.
British Journal
KAPLAN, I. (1972).
British
LANIER,V. L. and NJULE, H. W. (1974). Necrosis of penis with decubitus ulcer: debridement and closure with scrotal flap. Plastic andReconstructiv~ Surgery, 54,609.
DECUBITUS ULCER IN THE GROIN: REPAIR USING A TESTICULOSCROTAL FLAP By E. TAUBE, H. LABANDTERandI. KAPLAN Department of Plastic and Maxillo-Facial Surgery, Beilinson Medical Center, Petah Tiqva, Israel
A 24-YEAR-OLD MAN had been injured in a car accident 5 years before with damage to the spinal cord at D7-8 level; since then he is paraplegic. During the last 3 years he has suffered from recurrent decubitus ulcers which were treated elsewhere. On admission to our ward he had a deep ulcer, measuring IO x 12 cm in the right groin (Fig. I). In addition he had multiple smaller ulcers all around his pelvis: over the sacral area, left and right trochanteric areas and both ischial areas. Following correction of his anaemia and hypoalbuminaemia he was operated on.
FIG. I. Preoperative
view of sore in right groin.
After debridement it became apparent that the ulcer was extremly large. Laterally the cavity abutted on the femoral vessels, distally almost to the adductor canal. The pubic ramus was involved, the cavity extending behind the penile shaft. An adductor muscle flap was rotated from its proximal insertion to cover the femoral vessels. Following this procedure, a large medial cavity remained which we felt could not be adequately covered with a skin flap alone. A rotation flap of the scrotum was used, bringing the right testicle into the defect to fill the dead space (Fig. 2). Suction drainage was continued for a week. A large amount of sterile fluid, probably lymph, was discharged via the drain, 86
DECUBITUS
FIG. 2.
ULCER
IN
THE
GROIN
87
A large scrotal flap and the right testicle rotated into the defect. FIG. 3. Healed result 14 days postoperatively.
but after its removal the discharge ceased and the patient is now fit to undergo closure of his other sores (Fig. 3). DISCUSSION
In a series of 1,000 paraplegic cases described by Conway and Griffith (1956) no decubitus ulcers in the groin are mentioned, and we believe this is the first published case. The mechanism of development is not quite understood. We surmise that prolonged pressure of a urine bottle over the anaesthetic region was largely contributory. A scrotal Aap to repair an ischial decubitus ulcer was described by Kaplan (1972). The versatility of the scrotal flap has now been established having been used in sores of the ischium, pubis (Lanier and Neale, 1974) and now the inguinal area. In this case the testicle was also used as a space filler. REFERENCES CONWAY,H. and GRIFFITH, B. H. (1956). Plastic surgery for closure of decubitus ulcers in patients with paraplegia: based on experience with IOOOcases. American Journal of Surgery, 91,946.
of Plastic Surgery,
The scrotal flap in is&al
KAPLAN, I. (1976).
The scrotal flap repair for ischial decubitus ulcers: a follow-up.
q,22.
Journal
of Plastic Surgery,
29, 34.
decubitus.
British Journal
KAPLAN, I. (1972).
British
LANIER,V. L. and NJULE, H. W. (1974). Necrosis of penis with decubitus ulcer: debridement and closure with scrotal flap. Plastic andReconstructiv~ Surgery, 54,609.
