Kwon EO et al. (2008) Scrotal reconstruction using rapid intraoperative tissue expansion: a preliminary report. J Urol 179: 207–209

Surgical reconstruction for extensive scrotal tissue loss usually requires scrotal approximation or tissue transplantation. Rapid intraoperative tissue expansion (RITE) involves swift, single-stage stretching of skin from local tissue, which facilitates a tension-free closure without the need for tissue transplantation. Although RITE is presently used for other reconstructions (e.g. facial and extremity defects), its genitourinary applications have not been extensively explored. Kwon and colleagues report their experience of RITE for scrotal reconstruction.

Ten patients underwent scrotal reconstruction for necrotizing fasciitis at the authors' center between 1996 and 2006, of whom three underwent the RITE procedure; these patients had defects affecting 70–80% of the scrotal skin, which ruled out tension-free closure. The RITE technique involved subdermal insertion of 300 ml tissue expanders in the residual scrotal tissue and medial anterior thigh flaps, which were then inflated for 4 × 5 min periods, separated by 2 min rest intervals. The expanded skin was used to perform a layered midline closure of the scrotum.

All three patients had satisfactory functional and cosmetic results after surgery, and were discharged from hospital the following day. No postoperative complications were observed during the 12-month follow-up period; their pain was managed with NSAIDs, and no patient required narcotic analgesia.

The authors conclude that, in select cases of extensive, partial, scrotal skin defects, closure with the RITE technique is cosmetically and functionally comparable to that achieved with complex tissue transfer and staged tissue expansion; the procedure might also be useful in other genitourinary reconstruction settings.