• Archives of Plastic Surgery
• /
• v.47 no.4
• /
• pp.354-359
• /
• 2020

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearm-based flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

• Parasites, Hosts and Diseases
• /
• v.50 no.4
• /
• pp.353-355
• /
• 2012

We report here a case of inguinal sparganosis, initially regarded as myeloid sarcoma, diagnosed in a patient undergone allogeneic hematopoietic transplantation (HSCT). A 56-year-old male patient having myelodysplastic syndrome was treated with allogeneic HSCT after myeloablative conditioning regimen. At day 5 post-HSCT, the patient complained of a painless palpable mass on the left scrotum and inguinal area. Pelvic magnetic resonance imaging and computed tomography revealed suspected myeloid sarcoma. Gun-biopsy was performed, and the result revealed eosinophilic infiltrations without malignancy. Subsequent serologic IgG antibody test was positive for sparganum. Excisional biopsy as a therapeutic diagnosis was done, and the diagnosis of sparganosis was confirmed eventually. This is the first report of sparganosis after allogeneic HSCT mimicking myeloid sarcoma, giving a lesson that the physicians have to consider the possibility of sparganosis in this clinical situation and perform adequate diagnostic and therapeutic approaches.

• Parasites, Hosts and Diseases
• /
• v.52 no.1
• /
• pp.69-73
• /
• 2014

Sparganosis is a parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra. Although the destination of the larva is often a tissue or muscle in the chest, abdominal wall, extremities, eyes, brain, urinary tract, spinal canal, and scrotum, intramuscular sparganosis is uncommon and therefore is difficult to distinguish from a soft tissue tumor. We report a case of intramuscular sparganosis involving the gastrocnemius muscle in an elderly patient who was diagnosed using ultrasonography and MRI and treated by surgical excision. At approximately 1 cm near the schwannoma at the right distal sciatic nerve, several spargana worms were detected and removed.

• Archives of Plastic Surgery
• /
• v.49 no.3
• /
• pp.453-456
• /
• 2022

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name "sombrero" as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design "sombrero" modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

• Journal of Genetic Medicine
• /
• v.19 no.2
• /
• pp.115-119
• /
• 2022

The 46,XX testicular disorder of sex development (DSD) is a rare condition in which 46,XX individuals develop testicular differentiation and virilization. Translocation of the sex-determining region Y (SRY) onto the X chromosome is the main cause of 46,XX testicular DSD, whereas dysregulation between pro-testis and pro-ovarian genes can induce SRY-negative 46,XX testicular DSD. Nuclear receptor subfamily 5 group A member 1 (NR5A1), a nuclear receptor transcription factor, plays an essential role in gonadal development in XY and XX embryos. Herein, we report the first Korean case of SRY-negative 46,XX testicular DSD with a heterozygous NR5A1 p.Arg92Trp variant. The patient presented with a small penis, bifid scrotum, and bilateral undescended testes. Whole exome sequencing revealed a heterozygous missense variant (c.274C>T) of NR5A1. Our case highlights that NR5A1 gene variants need to be considered important causative factors of SRY-negative non-syndromic 46,XX testicular DSD.

• Clinical Pain
• /
• v.18 no.1
• /
• pp.36-39
• /
• 2019

Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.

• Journal of the Korean Society of Radiology
• /
• v.81 no.5
• /
• pp.1255-1259
• /
• 2020

We report the ultrasonographic and MRI findings of an infected sclerosing lipogranuloma after scrotal hernioplasty. Sclerosing lipogranuloma is a rare foreign-body reaction of fat tissue, with most cases being associated with the genital and urinary tracts. To the best of our knowledge, MRI findings in sclerosing lipogranuloma in the scrotal sac have not yet been published and this is possibly the first study to report the case of an infected sclerosing lipogranuloma in the English literature.

• Clinical and Experimental Reproductive Medicine
• /
• v.2 no.1
• /
• pp.19-38
• /
• 1975

A total of 185 vasovasostomies were carried out for 11 years. Various factors which are of importance in fluencing the successful vasovasostomies are analysed and presented as follows: In recent years, demand of reanastomosis of the vas deferens increased considerably. An average age of the subjects is 39, and that of their wives, 33 in this series. An average interval between vasectomy and vasovasostomy is 4 years. An average number of living chidren is 2.6 at the time of vasectomy. and 2.1 at the time of time of vasovasostomy. Merchant and public official are the most commonly encounterd occupation in the present series. Coital frequencies are 2.2/week after vasovasostomy. The most common reasons for requesting the vasovasostomy are remarriage and deaths of children, especially son. Success rate is considerably higher among younger group than that of the older. Success rate is somewhat higher among groups of shorter interval between the operations (vasectomy and vasovasostomy) than that of longer interval group. Success rate is higher among bilateral vasovasostomy group than that of any others. Success rate is higher in solid splint group and no splint group than hollow splint group. The closed dressing technique of the end of splint on the scrotum is found to be reasonably effective in preventing infection. Ordinary end-to-end anastomosis and folded side-to-side anastomosis techniques are proved to be the most ideal form of modified operation for the successful vasovasostomies. The most common causes of failure are infection, injuries of blood supply, avascular necrosis due to extensive mobilization, inadequate approximation of both vasal end, hematoma, changes of epididymal environment, and early ambulation in this series. Overall success rate of the author's series is found the 81 per cent, and impregnation rate is 35 per cent. Overall results reported by other workers are that success rate regarding appearance of sperm in the semen after operation is 64 per cent, and that of impregnation after vasovasostomy is 33 per cent. The results of semen assessment performed on same cases prior to vasectomy and following vasovasostomy showed that post-vasovasostomy sperm count scarcely reached three-quaters of pre-vasectomy count.

• Journal of the Korea Fashion and Costume Design Association
• /
• v.18 no.1
• /
• pp.169-181
• /
• 2016

This study analyzed the characteristics and patterns of men's drawers panties to get basic data for their design. For this, drawers panties in 7 different brands (4: domestic brands, 3: imported brands) in terms of a front-center shape were collected, and the shape of men's drawers panties, characteristics of the materials, dimensions & type of patterns by the part and front-center patterns were analyzed. The study results found the followings: First, in terms of the shape of men's drawers panties, the front-center part were designed to rest the penis and scrotum in a natural and comfortable manner without a pee slit. They were seamless on the sides except for one product with side seams. Second, the drawer panties were made of elastic polyurethane materials. Specifically, domestic brand items used warm, elastic and durable nylon, polyester and rayon and polyurethanes while imported brands were mostly made of absorbent and sanitary polyurethanes. Third, regarding a size of drawer panties by part, imported brands were large in waist circumference. In terms of waist breadth at the front center, there was difference depending on an oval type. In addition, the front length at the front center differed by product, revealing difference in three-dimensional effect at the front center. The side length also differed greatly by product, which means that there might be a great difference in wear comfort. Fourth, in terms of the patterns of men's drawers panties, there was difference in side seams, center back seam and front-center patterns. Among a total of 7 products, only one product had side seams, and center back seams were found in two products only. Fifth, in terms of front-center patterns, the drawer panties can be divided into three types, creating three-dimensional effect not to give any pressure on the crotch: i) the cutting line only at the bottom of the front center part where the penis is rested, ii) puff created at the front center by adding a transverse line to the center line, iii) cutting transverse line to separate the penis from the testicles.

• Journal of Veterinary Clinics
• /
• v.26 no.4
• /
• pp.331-335
• /
• 2009

This paper was performed to investigate the propensity of the diameter of maximum distended urethra from urethra to os penis in mature male dogs of 25 male dogs of different breeds. The measured sites of urethras were divided into 7 regions, i.e. prostate, membrane, isthmus, perineum, scrotum, prescrotum and os penis. By using the inflated balloon catheter filled with contrast medium, the maximum diameter of the distended urethras of each region was recorded and compared among regions. The mean diameter of the lumen from the prostatic urethra to the os penis urethra was gradually narrowed except for the isthmus portion, with a sense of resistance for retraction being noted at the level of ischiatic arch in 22 dogs. Proposed results from this should be utilized as a predictor of a treatment plan for the removal of urethroliths using an urohydropropulsion.