Scrotal reconstruction using tissue expanders

The reconstruction of scrotal skin following trauma, infection or congenital anomalies of the genitalia often poses great difficulty for the plastic surgeon. The bacterial flora of the area, the peculiar anatomy of the male genitalia and the need for maintenance of testicular function in a normal, thermoregulatory space narrow the reconstructive alternatives and make aesthetic scrotal reconstruction difficult. Tissue expansion has been used successfully for reconstruction following many congenital and acquired problems (1-4). It has the advantages of providing healthy tissue, causing only minor donor site morbidity and improving aesthetic results. We present a case of a hypoplastic scrotum in a pseudohermaphrodite child with cryptorchidism and describe an alternative method of scrotal reconstruction by using two soft tissue expanders for the purpose of creating space for the testes. CASE PRESENTATION This extremely interesting four-year-old child was born prematurely with significant ambiguity of the genitalia. The penis was very short, with a completely dysplastic scrotum, severe perineal hypospadias and ectopically palpable gonads outside the external inguinal ring. There was no evidence of any mullerian duct derivatives. The karyotype was assessed to be 46XY, and after complete investigation, the child was found to be a male pseudohermaphrodite. After considerable debate among the Division of Urology and Endocrinology at The Hospital for Sick Children, Toronto, Ontario, it was decided that the child would be raised as a male, on the basis of a positive response to testosterone and the size of the phallus and male karyotype. The child underwent extensive reconstruction of the genitalia and presented with a hypoplastic scrotum to accommodate the