Miko24
Guru
PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma of the dorsal penile shaft
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURES PERFORMED:
1. Penile sparing excision of penile skin cancer,
2. complex scrotoplasty
3. Adjacent rotational soft tissue transfer
FINDINGS:
1. Approximately 1 cm x 2 cm nodular erythematous lesion on the dorsum of the mid penile shaft, with surrounding evidence of lichen sclerosus
2. Close primarily with scrotal skin flap without need for skin graft
INDICATIONS:
36-year-old obese male with buried penis due to phimotic ring that has developed a red nodular lesion at the dorsum of the phimotic ring that been biopsied by dermatology and found to be squamous cell carcinoma. Presents today for excision of the mass and closure of the skin defects
PROCEDURE DETAILS:
The procedure began by placing tacking sutures through the phimotic ring and placing on traction. Scalpel was used to make a ventral incision through the cicatrix which then allowed for the glans of the penis to be exposed. Which was then prepped with Betadine. The field was irrigated and gloves were changed. Traction stitch was placed to the glans. The penis was placed on stretch and the area of abnormality was marked out an ellipse planned incision approximately 2 cm wide by 3 cm long. Aiming to give plenty of margin from the abnormal appearing tumor. 15 blade scalpel was used to incise through skin and dartos and then Metzenbaum scissors were used to complete the excision of the mass including some deeper dartos tissue. The remaining deep penile structures were palpably normal. The mass was tagged with black suture distally white suture proximally purple suture on the left side. And sent for frozen permanent specimen. Frozen sections were taken by removing a small amount of skin at the proximal distal left right and deep margins. These returned as negative for squamous cell carcinoma. There was condyloma present on the skin once. Additional skin was subsequently excised. The skin was inspected there was evidence of lichen sclerosis at the mucosal collar was much of this as possible was sharply excised and sent for 2 more permanent specimens as left and right penile shaft skin. The penis was placed on stretch and the remaining penile skin and scrotal skin was examined for feasibility of closing primarily with out graft. On the dorsum lateral edges of skin were brought together in the midline without placing too much tension and approximated with a 4-0 Vicryl. This was then approximated to the skin just proximal to the glans with 4-0 Vicryl's. The existing ventral skin defect was lengthened down to the scrotum with Metzenbaum scissors including the dartos. In the left proximal penile and scrotal skin was then rotated and flaps to cover the right side and ventrum of the penis this was all secured in place with 4-0 Vicryl's. The wound was then sequentially closed making sure nothing was kept on traction. In any disease skin was excised. The scrotal incision was extended inferiorly. To drop the scrotum further down on the penile shaft this was then secured in place with 4-0 Vicryl's. Hemostasis was achieved. The dartos was closed with a running 3-0 Vicryl for hemostasis. Skin was approximated 4-0 Vicryl's and then the incisions were closed all the way around with interrupted 4-0 Vicryl's. That the procedure the penis was inspected to ensure that it would not be on any tension in any particular direction and this was achieved. A 16 French catheter was then placed to the meatus the meatus was noted to be stenotic and required dilation with a hemostat. 10 mL in the balloon. Sterile dressing was placed.
Any help is greatly appreciated...
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURES PERFORMED:
1. Penile sparing excision of penile skin cancer,
2. complex scrotoplasty
3. Adjacent rotational soft tissue transfer
FINDINGS:
1. Approximately 1 cm x 2 cm nodular erythematous lesion on the dorsum of the mid penile shaft, with surrounding evidence of lichen sclerosus
2. Close primarily with scrotal skin flap without need for skin graft
INDICATIONS:
36-year-old obese male with buried penis due to phimotic ring that has developed a red nodular lesion at the dorsum of the phimotic ring that been biopsied by dermatology and found to be squamous cell carcinoma. Presents today for excision of the mass and closure of the skin defects
PROCEDURE DETAILS:
The procedure began by placing tacking sutures through the phimotic ring and placing on traction. Scalpel was used to make a ventral incision through the cicatrix which then allowed for the glans of the penis to be exposed. Which was then prepped with Betadine. The field was irrigated and gloves were changed. Traction stitch was placed to the glans. The penis was placed on stretch and the area of abnormality was marked out an ellipse planned incision approximately 2 cm wide by 3 cm long. Aiming to give plenty of margin from the abnormal appearing tumor. 15 blade scalpel was used to incise through skin and dartos and then Metzenbaum scissors were used to complete the excision of the mass including some deeper dartos tissue. The remaining deep penile structures were palpably normal. The mass was tagged with black suture distally white suture proximally purple suture on the left side. And sent for frozen permanent specimen. Frozen sections were taken by removing a small amount of skin at the proximal distal left right and deep margins. These returned as negative for squamous cell carcinoma. There was condyloma present on the skin once. Additional skin was subsequently excised. The skin was inspected there was evidence of lichen sclerosis at the mucosal collar was much of this as possible was sharply excised and sent for 2 more permanent specimens as left and right penile shaft skin. The penis was placed on stretch and the remaining penile skin and scrotal skin was examined for feasibility of closing primarily with out graft. On the dorsum lateral edges of skin were brought together in the midline without placing too much tension and approximated with a 4-0 Vicryl. This was then approximated to the skin just proximal to the glans with 4-0 Vicryl's. The existing ventral skin defect was lengthened down to the scrotum with Metzenbaum scissors including the dartos. In the left proximal penile and scrotal skin was then rotated and flaps to cover the right side and ventrum of the penis this was all secured in place with 4-0 Vicryl's. The wound was then sequentially closed making sure nothing was kept on traction. In any disease skin was excised. The scrotal incision was extended inferiorly. To drop the scrotum further down on the penile shaft this was then secured in place with 4-0 Vicryl's. Hemostasis was achieved. The dartos was closed with a running 3-0 Vicryl for hemostasis. Skin was approximated 4-0 Vicryl's and then the incisions were closed all the way around with interrupted 4-0 Vicryl's. That the procedure the penis was inspected to ensure that it would not be on any tension in any particular direction and this was achieved. A 16 French catheter was then placed to the meatus the meatus was noted to be stenotic and required dilation with a hemostat. 10 mL in the balloon. Sterile dressing was placed.
Any help is greatly appreciated...