Resumen Paciente sexo masculino de 64 años, con antecedentes de hipertensión arterial y dislipemia en tratamiento, consulta por dermatosis asintomática en escroto de aproximadamente 30 años de evolución. Al examen físico se observan lesiones tumorales blanco-amarillentas, sólidas, de consistencia dura, sin adherencia a planos profundos, de tamaño variado, sin adenopatías asociadas, localizadas en escroto. Se solicita laboratorio de rutina, sin particularidades, con resultados normales de paratohormona,calcemia, fosfatemia y vitamina D. Se solicita radiografía de tórax, que informa ausencia de imágenes patológicas,y serealiza toma de biopsiapara anatomía patológica,compatible con calcinosis de escroto. Se propone tratamiento quirúrgico, al cual el paciente se niega. Interés del caso: Surge al tratarse de una patología poco frecuente, y por lo tanto con escasa bibliografía al respecto, además de la importancia de la posible comorbilidad que puede acompañarla.

Abstract A 64-year-old male patient, with a history of high blood pressure and dyslipidemia under treatment, presents an asymptomatic dermatosis in the scrotum of approximately 30 years of evolution. On physical examination, white-yellowish tumors of different sizes were observed at the scrotum. These lesions or tumors were solid and seemed to be superficial. No lymphadenopathy was found. A routine laboratory was requested without any particularities, with normal results of parathormone, calcium, phosphatemia and vitamin D. A chest x-ray was also requested, which showed no abnormalities. Finally, a biopsy was performed with pathological results compatible with scrotal calcinosis. Surgical treatment was proposed, which the patient refuses. Case interest: infrequent pathology, scarcebibliography, important the search for associated diseases.

ABSTRACT Introduction: acute surgical scrotum is one of the most frequent emergencies in pediatric age. Objective: to describe epidemiological, clinical and surgical aspects of children with acute scrotum. Methods: a descriptive and cross-sectional investigation was carried out in the Pediatric Surgery Service belonging to the “José Luis Miranda” University Pediatric Hospital of Villa Clara. The population was made up of a total of 117 children with a diagnosis of acute scrotum during the period from 2017 to 2021. Documentary analysis of medical records was used in data collection and descriptive and inferential statistics in the analysis. Results: the age group 10 to 18 years (52.99%) and those from the Municipality of Santa Clara (58.12%) prevailed. The most frequent clinical manifestations were pain (97.44%) and flushing (99.15%). Hydatid torsion (54.55%) and testicular torsion (58.82%) predominated in the adolescent and the evolution time ranged from six to 24 hours. 75.21% were diagnosed by the clinical method and treated with scrototomy and excision of the hydatid. Conclusions: currently the management of acute scrotal syndrome is a challenge. It is a pediatric emergency that requires timely medical action to avoid complications.

RESUMEN Introducción: el escroto agudo quirúrgico es una de las urgencias más frecuentes en la edad pediátrica. Objetivo: describir aspectos epidemiológicos, clínicos y quirúrgicos de niños con escroto agudo. Métodos: se realizó una investigación descriptiva y transversal en el Servicio de Cirugía pediátrica perteneciente al Hospital Pediátrico Universitario “José Luis Miranda” de Villa Clara. La población estuvo formada por el total de 117 niños con diagnóstico de escroto agudo durante el período de 2017 a 2021. Se utilizaron el análisis documental de las historias clínicas en la recolección del dato y la estadística descriptiva e inferencial en el análisis. Resultados: prevaleció el grupo de edad 10 a 18 años (52,99%) y los procedentes del Municipio de Santa Clara (58,12%). Las manifestaciones clínicas más frecuentes fueron el dolor (97,44%) y el rubor (99,15%). Predominaron en el adolescente la torsión de la hidátides (54,55%) y la testicular (58,82%) y el tiempo de evolución de seis a 24 horas. El 75,21% fue diagnosticado por el método clínico y tratado con escrototomía y excéresis de la hidátide. Conclusiones: en la actualidad el manejo del síndrome del escroto agudo es un desafío. Es una urgencia pediátrica que requiere actuación médica oportuna para evitar complicaciones.

Resumo A miíase humana é a infestação de humanos por larvas de dípteros. A forma cutânea é a mais frequente apresentação da doença e também uma das doenças dermatológicas do viajante mais comuns. Deve haver suspeita de miíase cutânea quando são observadas lesões do tipo furúnculo ou bolha em doentes que estiveram numa região endémica. É descrito o caso de um rapaz de 17 meses oriundo da Guiné-Bissau que se apresentou com lesões do tipo furúnculo dolorosas na coxa esquerda e escroto com seis dias de evolução. Foram recuperadas duas larvas numa das lesões, cuja análise entomológica confirmou o diagnóstico de miíase cutânea. A extração completa das larvas é o principal objetivo do tratamento e a sua correta preservação para análise é fundamental numa perspetiva de saúde pública.

Abstract Human myiasis is the infestation of humans with dipterous larvae. Cutaneous myiasis is the most common form and is one of the most common travel-associated skin diseases. The condition should be suspected when furuncle or boil-like skin lesions are observed in patients travelling from endemic regions. Herein is described the case of a toddler who had travelled from Guinea-Bissau seven days earlier and presented with a six-day history of painful furuncle-like swellings on the left thigh and scrotum. Two larvae were collected from one of the lesions, and entomological analysis confirmed the diagnosis of cutaneous myiasis. Complete larvae extraction is the primary treatment goal, and adequate preservation of the maggots is essential for public health analysis.

ABSTRACT Liposarcoma is a mesenchymal origin tumor that commonly occurs in the retroperitoneum; It is slow growing and its ability to produce metastasis depends on its histological type. The purpose of this work is to present a case of simultaneous paratesticular liposarcomas with different histological types, in an 80-years-old male patient with a health history and low socioeconomic level; For two years he had been experiencing an increase in volume in the left inguinal region and ipsilateral testicle, which at first was painless; Then, as it increased in size, it became painful, covering the entire right inguinoscrotal region. Physical examination, including transillumination sign, was negative. The analytical study only showed erythrocyte sedimentation rate at 95 mm/h and LDH at 650 U/l; The testicular ultrasound showed heterogeneous, solid and hyperechoic mass, with a fatty inguinoscrotal appearance and measuring more tan 30 cm, without the testicle being observed. Tumor excision was performed and three liposarcomatous tumors were found, two of them with similar histopathological characteristics and the other with a different histological pattern. After the surgical treatment, the patient recovered satisfactorily and has not had a recurrence according to the periodic controls carried out. The publication of the case was considered because liposarcomas can be confused on clinical examination with the presence of an inguinal hernia with fatty content with symptoms similar to these; Therefore, a thorough clinical examination must be performed to make a correct diagnosis. The histopathological study confirmed the diagnosis of the disease; which, in addition, revealed the presence of three liposarcomatous tumors and two histopathological variants of the same, from which no reports were found in the reviewed literature.

RESUMEN El liposarcoma es un tumor de origen mesenquimal que se presenta comúnmente en el retroperitoneo; es de crecimiento lento y su capacidad de producir metástasis depende de su tipo histológico. Este trabajo tiene como propósito presentar un caso de liposarcomas paratesticulares simultáneos con diferentes tipos histológicos, en un paciente masculino, de 80 años con antecedentes de salud y nivel socioeconómico bajo que venía presentando desde hacía dos años aumento de volumen en la región inguinal izquierda y testículo ipsilateral, al inicio fue indoloro; luego, a medida que aumentó de tamaño se tornó doloroso, abarcando la región inguinoescrotal derecha en su totalidad. El examen físico, incluido el signo de la transiluminación fue negativo. El estudio analítico mostró solamente velocidad de sedimentación globular en 95 mm/h y la LDH en 650 U/l; la ecografía testicular mostró una masa heterogénea, solida e hiperecoica, de aspecto graso inguinoescrotal y de más de 30 cm, sin llegarse a observar el testículo. Se realizó exéresis tumoral encontrándose tres tumores liposarcomatosos, dos de ellos con características histopatológicas similares y el otro con patrón histológico diferente. Luego del tratamiento quirúrgico el paciente se recuperó satisfactoriamente y no ha presentado recidiva según los controles periódicos realizados. Se consideró la publicación del caso pues los liposarcomas pueden llegar a confundirse a la exploración clínica con la presencia de una hernia inguinal de contenido graso con sintomatología similar a estas; por lo que debe hacerse una exploración clínica exhaustiva para realizar un correcto diagnóstico. El estudio histopatológico confirmó el diagnóstico de la enfermedad que, además, reveló la presencia de tres tumores liposarcomatosos y dos variantes histopatológicas del mismo, de lo cual no se encontraron reportes en la literatura revisada.

ABSTRACT The breast form of Mondor syndrome is a rare and self-limited condition characterized by thrombophlebitis of the superficial veins of the breast. Understanding this syndrome is extremely important for correct diagnosis and precise, non-iatrogenic treatment, given that it has a considerable relationship with breast carcinoma. This case report portrays the emergence of Mondor syndrome in a young 22-year-old patient, after breast augmentation. The characteristic sign of the condition, the fibrous cord, appeared in the right breast from the twenty-third day after surgery, disappearing completely after 10 weeks. The diagnosis was given by the plastic surgeon who followed the patient through anamnesis and physical examination, without the urgency of a complementary exam, such as a mammography. It is worth mentioning that this rare condition can affect males - less frequently - and affect other regions, such as the penis and scrotum. Furthermore, it is beneficial to recognize and diagnose Mondor syndrome, as surgeries using phytoaesthetics are constantly growing today, intending to guide patients in the best way possible for an effective and less invasive treatment (except in the concomitant presence of cancer). breast, for example), in addition to reassuring them about the condition. selflimited self limited precise noniatrogenic non iatrogenic carcinoma 22yearold yearold 22 year old augmentation cord twentythird twenty third surgery 1 weeks examination exam mammography regions scrotum Furthermore today except cancer. cancer . cancer) example, example , example) 2

RESUMO A forma mamária da síndrome de Mondor é uma afecção rara e autolimitada que se caracteriza pela tromboflebite de veias superficiais da mama. Entender tal síndrome é de suma importância para o diagnóstico correto e o tratamento preciso e não iatrogênico, tendo em vista apresentar considerável relação com o carcinoma mamário. Esse relato de caso retrata o surgimento da síndrome de Mondor em uma paciente jovem de 22 anos, após uma mamoplastia de aumento. O sinal característico da afecção, o cordão fibroso, manifestou-se na mama direita a partir do vigésimo terceiro dia de pós-operatório, desaparecendo por completo após 10 semanas. O diagnóstico foi dado pelo cirurgião plástico que acompanhou a paciente mediante anamnese e exame físico, sem a urgência de um exame complementar, como a mamografia. Vale ressaltar que tal afecção rara pode acometer o sexo masculino - em menor frequência - e afetar outras regiões, como o pênis e o escroto. Ademais, é salutar reconhecer e diagnosticar a síndrome de Mondor, visto que as cirurgias com o fitoestético estão em constante crescimento na atualidade, com o escopo de conduzir os pacientes da melhor forma para um tratamento eficaz e menos invasivo (exceto na presença concomitante de câncer de mama, por exemplo), além de tranquilizá-los a respeito da afecção. iatrogênico mamário 2 anos aumento fibroso manifestouse manifestou pósoperatório, pósoperatório pós operatório, operatório pós-operatório 1 semanas físico complementar mamografia regiões escroto Ademais atualidade exceto exemplo, exemplo , exemplo) tranquilizálos tranquilizá los

Resumo O angioceratoma de Fordyce é um tipo de lesão vascular de caráter benigno, que compromete as genitálias externas masculina e feminina, cuja prevalência é desconhecida e sem componente hereditário aparente. O diagnóstico pode ser sugerido à ectoscopia pela presença de pápulas púrpuras, azuladas, negras ou vermelhas na vulva, clitóris, escroto, corpo ou glande do pênis. A maioria dos pacientes é assintomática. Vários métodos têm sido utilizados para o tratamento, incluindo cirurgia, eletrocoagulação, cauterização química, escleroterapia e laser. A eficácia e as complicações dessas terapias são variadas. O propósito deste artigo é relatar o caso de uma mulher de 56 anos de idade apresentando lesões vulvares abundantes e dolorosas, tratadas com o laser de pulso longo Nd: YAG de 1.064 nm. O laser Nd: YAG de 1.064 nm apresentou-se como uma opção terapêutica viável, com resultados satisfatórios e baixo índice de complicações. benigno feminina aparente púrpuras azuladas vulva clitóris escroto pênis assintomática tratamento cirurgia eletrocoagulação química variadas 5 dolorosas Nd 1064 1 064 1.06 apresentouse apresentou se viável 106 06 1.0 10 0 1.

Abstract Fordyce's Angiokeratoma (AKF) is a benign type of vascular lesion that affects the male and female external genitalia. Prevalence is unknown and there is no apparent hereditary component. Diagnosis can be suggested by ectoscopy, by the presence of purple, bluish, black or red papules on the vulva, clitoris, scrotum, or penis body or glans. Most patients are asymptomatic. Various methods have been used for treatment, including surgery, electrocoagulation, chemical cauterization, sclerotherapy, and LASER. The effectiveness and complications of these therapies are varied. The purpose of this article is to report the case of a 56-year-old woman with abundant and painful vulvar lesions treated with a 1064 nm Nd:YAG LASER. The 1064 nm Nd:YAG LASER proved to be a viable therapeutic option, with satisfactory results and a low rate of complications. Fordyces Fordyce s AKF (AKF genitalia component ectoscopy purple bluish vulva clitoris scrotum glans asymptomatic treatment surgery electrocoagulation cauterization sclerotherapy varied 56yearold yearold 56 year old 106 NdYAG Nd YAG option 5 10 1

RESUMO: Distúrbios do trato reprodutivo masculino (DTRMs) são comuns em equídeos e podem representar uma proporção significativa da casuística de hipiatras. Determinamos a frequência, os achados clínico-patológicos e a terapêutica de DTRMs em equídeos a partir de um levantamento de nove anos dos registros clínicos em um Hospital Veterinário no Centro-Oeste do Brasil. Nesse período, 87 equinos afetados apresentaram 100 DTRMs distribuídos em 17 diagnósticos diferentes. Quarenta e três (49,4%) equídeos apresentaram DTRM afetando a glande peniana ou pregas de pele prepucial. Distúrbios dos testículos, escroto e cordão espermático foram diagnosticados em 32 (36,8%) equinos. Dos 12 (13,8%) equinos restantes, seis apresentaram dois DTRMs diferentes em duas áreas anatômicas distintas, e cinco animais exibiram a mesma doença em duas localizações anatômicas diferentes. Apenas um cavalo apresentou três DTRMs distintas em duas regiões anatômicas. A habronemíase foi a DTRM mais frequente detectada em 26% dos diagnósticos, seguida por feridas diversas (14%), criptorquidismo (13%), hérnia inguinal (13%), funiculite (9%), parafimose (6%), carcinoma de células escamosas (5%), uretrolitíase (3%), abscessos prepuciais e orquite (2% cada). Fimose, postite ulcerativa, epididimite, hidrocele, papilomatose, teratoma e torção testicular representaram 1% cada. Sessenta e três (72,5%) equídeos receberam alta hospitalar, 18 (20,6%) foram sacrificados humanitariamente e seis (6,9%) morreram. Este estudo detectou as DTRMs mais relevantes que afetaram 7,5% dos pacientes em um levantamento de 1.154 equídeos encaminhados para atendimento hospitalar. Este achado destaca que as DTRMs podem ser condições debilitantes e com risco de morte, e podem impactar potencialmente a reprodução de equídeos na região. Este conhecimento pode ajudar os hipiatras a elaborar protocolos sanitários e de manejo adequados para prevenir e reduzir a incidência da maioria das DTRMs registradas, melhorando a produção e o bem-estar dos equídeos. RESUMO (DTRMs frequência clínicopatológicos clínico patológicos CentroOeste Centro Oeste Brasil período 8 10 1 49,4% 494 49 4 (49,4% prepucial testículos 3 36,8% 368 36 (36,8% 13,8% 138 13 (13,8% restantes 26 14%, 14 14% , (14%) 13%, 13% (13%) 9%, 9 9% (9%) 6%, 6 6% (6%) 5%, 5 5% (5%) 3%, 3% (3%) 2% 2 (2 cada . cada) Fimose ulcerativa epididimite hidrocele papilomatose 72,5% 725 72 (72,5% hospitalar 20,6% 206 20 (20,6% 6,9% 69 (6,9% morreram 75 7 7,5 1154 154 1.15 morte região registradas bemestar bem estar 49,4 (49,4 36,8 (36,8 13,8 (13,8 (14% (13% (9% (6% (5% (3% ( 72,5 (72,5 20,6 (20,6 6,9 (6,9 7, 115 15 1.1 49, (49, 36, (36, 13, (13, (14 (13 (9 (6 (5 (3 72, (72, 20, (20, 6, (6, 11 1. (49 (36 (1 (72 (20 (4 (7

ABSTRACT: Male reproductive tract disorders (MRTDs) are common in equids and may represent a significant proportion of the caseload of equine practitioners. Herein, we determined the frequency, clinico-pathological findings, and therapeutics of MRTDs in equids from a 9-year survey of the clinical records of a Veterinary Teaching Hospital in Midwestern Brazil. During this period, 87 affected equids presented 100 MRTDs distributed in 17 different diagnoses. Forty-three (49.4%) equids presented MRTDs affecting the glans penis or preputial skin fold. Testicles, scrotum, and spermatic cords disorders were diagnosed in 32 (36.8%) horses. Of the remaining 12 (13.8%) horses, six presented two different MRTDs on two distinct anatomical areas, and five animals exhibited the same disease, affecting two different anatomical locations. Only one horse presented three distinct MRTDs on two anatomical regions. Habronemiasis was the most frequent MRTD detected in 26% of the diagnoses, followed by miscellaneous wounds (14%), cryptorchidism (13%), inguinal hernia (13%), funiculitis (9%), paraphimosis (6%), squamous cell carcinoma (5%), urethrolithiasis (3%), preputial abscesses, and orchitis (2% each). Phimosis, ulcerative posthitis, epididymitis, hydrocele, papillomatosis, teratoma, and testicular torsion accounted for 1% each. Sixty-three (72.5%) equids received hospital discharge, 18 (20.6%) were humanely euthanized, and six (6.9%) died. This study detected the most relevant MRTDs that affected over 7.5% in a survey of 1,154 equids referred for hospital care. Our finding highlights that MRTDs may be debilitating and life-threatening conditions, and they can potentially impact the reproduction of equids in the region. This knowledge may support equine practitioners in elaborating proper sanitary and management protocols to prevent and reduce the incidence of most MRTDs recorded, improving equid production and welfare. ABSTRACT (MRTDs Herein frequency clinicopathological clinico pathological findings 9year year 9 Brazil period 8 10 1 diagnoses Fortythree Forty 49.4% 494 49 4 (49.4% fold Testicles scrotum 3 36.8% 368 36 (36.8% horses 13.8% 138 13 (13.8% areas disease locations regions 26 14%, 14 14% , (14%) 13%, 13% (13%) 9%, 9% (9%) 6%, 6 6% (6%) 5%, 5 5% (5%) 3%, 3% (3%) abscesses 2% 2 (2 each . each) Phimosis posthitis epididymitis hydrocele papillomatosis teratoma Sixtythree Sixty 72.5% 725 72 (72.5% discharge 20.6% 206 20 (20.6% euthanized 6.9% 69 (6.9% died 75 7 7.5 1154 154 1,15 care lifethreatening life threatening conditions region recorded welfare 49.4 (49.4 36.8 (36.8 13.8 (13.8 (14% (13% (9% (6% (5% (3% ( 72.5 (72.5 20.6 (20.6 6.9 (6.9 7. 115 15 1,1 49. (49. 36. (36. 13. (13. (14 (13 (9 (6 (5 (3 72. (72. 20. (20. 6. (6. 11 1, (49 (36 (1 (72 (20 (4 (7

RESUMEN Introducción: el varicocele se considera el problema más común en la práctica de la medicina reproductiva en el género masculino. Objetivo: describir el diagnóstico y tratamiento del varicocele. Métodos: se realizó una revisión bibliográfica de la literatura mediante una búsqueda de información en las bases de dato PubMed, SciELO, y Scopus. Resultados: la gravedad del varicocele se clasifica de uno a tres según el examen clínico, destacando el grado 2 y 3, con una mala calidad del semen para posibles embarazos. Los síntomas informados con mayor frecuencia han sido tradicionalmente dilataciones varicosas en el escroto, indoloras e incomodas. En estas se realiza varicocelectomías laparoscópicas y abiertas, con alta el mismo día de la cirugía. Conclusión: para un adecuado diagnóstico cabe destacar que la primera herramienta diagnóstica es mediante la exploración física. La confirmación se realiza mediante ecografía Doppler testicular, la cual permite diagnosticar también los varicoceles subclínicos. Existe evidencia de un efecto positivo del tratamiento sobre los síntomas, los parámetros espermáticos y las tasas de embarazo.

ABSTRACT Introduction: varicocele is considered the most common problem in the practice of reproductive medicine in the male gender. Objective: to describe the diagnosis and treatment of varicocele. Methods: a bibliographic review of the literature was carried out by means of an information search in the databases PubMed, SciELO, and Scopus. Results: the severity of varicocele is classified from one to three according to clinical examination, highlighting grade 2 and 3, with poor semen quality for possible pregnancies. The most frequently reported symptoms have traditionally been varicose dilatations in the scrotum, painless and uncomfortable. In these cases laparoscopic and open varicocelectomies are performed, with discharge on the same day of surgery. Conclusion: for an adequate diagnosis it is important to emphasize that the first diagnostic tool is physical examination. Confirmation is made by testicular Doppler ultrasound, which also allows the diagnosis of subclinical varicoceles. There is evidence of a positive effect of treatment on symptoms, sperm parameters and pregnancy rates.

Resumen: Las quemaduras en genitales tienen una presentación clínica variable cuando no son tratadas oportunamente pueden aumentar el riesgo de morbilidad y mortalidad. El área anatómica comúnmente afectadas en el varón es el cuerpo del pene, estos pacientes requieren un desbridamiento quirúrgico extenso una vez delimitado el tejido afectado por la quemadura, presentando posteriormente defectos de piel complejos e irregulares. Los defectos de piel en el pene después de una quemadura severa deben tratarse tempranamente con el objetivo de reducir la necrosis tisular secundaria, preservar los tejidos funcionales y recuperar la textura elástica de la piel. Respecto a la experiencia de nuestro equipo quirúrgico con la utilización de injertos cutáneos de espesor parcial fino y en algunos casos un colgajo de escroto con la modificación en el diseño de la punta, los resultaron muestran que pueden ser herramienta útiles, proporcionar una cobertura cutánea definitiva, función sensitiva y elasticidad al emplearse tejido local con características similares, respecto a la técnica se puede realizar con mínima dificultad técnica y mínima morbilidad resultante, siempre recomendamos llevar un seguimiento a largo plazo, para evaluar los resultados estéticos funcionales y complicaciones que puedan presentarse.

Abstract: Genital burns have a variable clinical presentation when they are not treated promptly and can increase the risk of morbidity and mortality. The anatomical area commonly affected in men is the shaft of the penis; these patients require extensive surgical debridement once the tissue affected by the burn has been delimited, subsequently presenting complex and irregular skin defects. Skin defects on the penis after a severe burn should be treated early with the aim of reducing secondary tissue necrosis, preserving functional tissues and recovering the elastic texture of the skin. Regarding the experience of our surgical team with the use of thin partial thickness skin grafts and in some cases a scrotum flap with modification in the tip design, the results show that they can be useful tools, providing definitive skin coverage. , sensory function and elasticity when local tissue with similar characteristics is used. Regarding the technique, it can be performed with minimal technical difficulty and minimal resulting morbidity. We always recommend long-term follow-up to evaluate the functional aesthetic results and complications that may arise.

RESUMEN La elefantiasis escrotal es una condición que ha sido históricamente descripta en áreas endémicas de filariasis, pero es menos frecuente su presentación idiopática o asociada a otras entidades. Presentamos un caso de elefantiasis escrotal gigante de causa adquirida idiopática, al que se le practicó la exéresis de la estructura linfedematosa y la reconstrucción del defecto con colgajos locales y autoinjerto cutáneo. El motivo de su divulgación radica en que se trata de un caso muy poco frecuente, ya sea por la baja incidencia y etiología, así como por la importante magnitud del problema para el individuo. El objetivo principal en el tratamiento del linfedema, en el caso presentado, fue devolverle al paciente funciones primarias y elementales de vida, además de disminuir la morbilidad y otorgarle una mejor calidad de vida.

ABSTRACT Scrotal elephantiasis is a condition that has been historically described in areas where filariasis is endemic, but idiopathic cases or those associated with other entities are rare. We report a case of a patient with idiopathic acquired giant scrotal elephantiasis who underwent excision of the lymphedematous structure and reconstruction of the defect with local flaps and skin autograft. The reason for this presentation is the uncommon nature of the case due to its low incidence, rare etiology and the magnitude of the problem experienced by the patient. The main goal in the treatment of lymphedema in this case was to restore primary and elementary functions of life to the patient, reduce morbidity and provide him with a better quality of life.

RESUMEN Los defectos en la región escrotal son producidos en la mayoría de los casos por la gangrena de Fournier, y en ocasiones por traumatismo o patologías oncológicas. Estas heridas generan mucha dificultad para el desarrollo de una vida normal a los pacientes que lo padecen; por lo general producen dolor, los testículos quedan desprotegidos y la espermatogénesis puede verse alterada. Actualmente no existe un método estándar de reconstrucción escrotal, y las técnicas tradicionalmente utilizadas no ofrecen una cobertura funcional ni estética. Generalmente producen mucho abultamiento en la región genital, que puede dificultar el movimiento de las piernas y el uso de pantalones. En este trabajo se expone una opción quirúrgica para reconstruir el escroto, por medio del colgajo pediculado de músculo gracilis bilateral e injerto de piel parcial. Para tal efecto, se presenta un caso clínico de un paciente de 64 años con secuelas en la región perineal, posterior a una gangrena de Fournier. El paciente presentaba una pérdida total del escroto y exposición de ambos testículos. El método arriba mencionado es una opción válida para reconstruir el escroto y en este trabajo se describe la técnica empleada de forma detallada, donde se puede apreciar que presenta escasas complicaciones y es fácil de reproducir por un cirujano plástico entrenado.

ABSTRACT Defects in the scrotal region are caused in most cases by Fournier's gangrene, and sometimes by trauma or oncological pathologies. These wounds generate difficulties for the development of a normal life; They usually produce pain; the testicles are unprotected and spermatogenesis can be altered. Currently there is no standard method of scrotal reconstruction, and the techniques traditionally used do not offer functional or aesthetic coverage. They generally produce a big bulge in the genital region, which can make it hard to move the legs and wear pants. A surgical option is exposed to reconstruct the scrotum, by means of the bilateral gracilis muscle pedicled flap and split-thickness skin graft. For this purpose, a clinical case of a 64-year-old patient with sequelae in the perineal region, after Fournier's gangrene, is presented. The patient presented a total loss of the scrotum and exposure of both testicles. The method mentioned above is a valid option to reconstruct the scrotum and the technique used is described in detail, where it can be seen that it is easy to reproduce by a trained plastic surgeon.

Abstract We report a case of Fournier's gangrene rescued by debridement. A 40-year-old male patient had a 2x2 cm draining ulcer and 1x2 cm necrotic area in the scrotum for about a month. The patient was diagnosed with Fournier's gangrene. Septic shock and disseminated intravascular coagulation were absent. Computed tomography scan showed soft tissue gas in the scrotum but no gas in the retroperitoneal space or abdominal wall. Debridement was performed. Gangrene of the scrotum and necrosis of the testicle was also seen. Rothia dentocariosa was isolated in extracted wound cultures. He was saved after debridement and administration of strong antibiotics. This is the first case of Fournier's gangrene caused by R. dentocariosa in the available literature.

Resumen Presentamos un caso de gangrena de Fournier rescatado mediante desbridamiento. Un paciente varón de 40 años presentó una úlcera supurante de 2x2 cm y un área necrótica de 1x2 cm en el escroto durante aproximadamente un mes. El paciente fue diagnosticado con gangrena de Fournier. El shock séptico y la coagulación intravascular diseminada estaban ausentes. La tomografía computarizada mostró gas en los tejidos blandos del escroto, pero no en el espacio retroperitoneal ni en la pared abdominal. Se realizó desbridamiento. También se observó gangrena del escroto y necrosis del testículo. Se aisló Rothia dentocariosa en cultivos extraídos de heridas. Se salvó después del desbridamiento y la administración de antibióticos fuertes. Este es el primer caso de gangrena de Fournier por R. dentocariosa en la literatura disponible.

RESUMO Introdução: Gangrena de Fournier é uma infecção polibacteriana, geralmente causada por bactérias anaeróbias e aeróbias, sendo caracterizada por fasciite necrosante escrotal e perineal. Seu tratamento é embasado em intervenção cirúrgica com excisão da área necrótica e antibioticoterapia precoces. Diversas são as estratégias de reconstrução do defeito resultante do desbridamento, devendo ser salientado que perdas teciduais maiores do que 50% costumam ser reconstruídas com retalhos. Métodos: Análise retrospectiva da série de casos de reconstrução escrotal após gangrena de Fournier procedidos pelos autores ao longo de 2020, totalizando oito pacientes. Resultados: O retalho mais utilizado foi o fasciocutâneo de coxa, que apresentou taxa de necrose parcial de 14,29%, sem necrose total. Em um dos casos foi possível reconstruir uma uretra esponjosa com músculo grácil sem fistulização, evitando que o paciente fosse submetido a uma uretrostomia definitiva. Quanto às complicações, foi comum a ocorrência de intercorrências menores que necessitaram de procedimentos revisionais simples. Destaca-se a prevalência de 75% de diabetes mellitus em nossa casuística, o que pode ter interferido negativamente no processo cicatricial. Conclusão: A reconstrução escrotal com retalhos é importante para acelerar a cicatrização da ferida proveniente do desbridamento de gangrena de Fournier e para manter o aspecto de bolsa necessário para a termorregulação do testículo. Nossa opção primária foi o retalho fasciocutâneo de coxa, que se mostrou seguro. Pequenas intercorrências foram frequentes nesta série, sem comprometimento do resultado final. Introdução polibacteriana aeróbias perineal precoces 50 Métodos 2020 pacientes Resultados coxa 1429 14 29 14,29% total fistulização definitiva complicações simples Destacase Destaca 75 casuística cicatricial Conclusão testículo seguro final 5 202 142 1 2 14,29 7 20 14,2 14,

ABSTRACT Introduction: Fournier’s gangrene is a polybacterial infection, usually caused by anaerobic and aerobic bacteria, characterized by scrotal and perineal necrotizing fasciitis. Its treatment is based on surgical intervention by excision of the necrotic area and early antibiotic therapy. There are several strategies to reconstruct the defect resulting from debridement, and it should be noted that tissue losses greater than 50% are usually reconstructed with flaps. Methods: Retrospective analysis of the series of cases of scrotal reconstruction after Fournier’s gangrene performed by the authors throughout 2020, totaling eight patients. Results: The most used flap was thigh fasciocutaneous flap, which presented a partial necrosis rate of 14.29%, without total necrosis. In one of the cases, it was possible to reconstruct a spongy urethra with gracilis muscle without fistulization, preventing the patient from undergoing a definitive urethrostomy. As for complications, the occurrence of minor complications that required simple revision procedures was common. The prevalence of 75% of diabetes mellitus in our series is highlighted, which may have negatively interfered with the healing process. Conclusion: Scrotal reconstruction with flaps is important to accelerate wound healing from Fournier gangrene debridement and to maintain the pouch aspect necessary for testicular thermoregulation. Our primary option was thigh fasciocutaneous flap, which proved to be safe. And minor complications were frequent in this series, without compromising the final result. Introduction Fourniers s infection bacteria fasciitis therapy 50 Methods 2020 patients Results 1429 14 29 14.29% fistulization urethrostomy common 75 highlighted process Conclusion thermoregulation safe result 5 202 142 1 2 14.29 7 20 14.2 14.

Resumen: Introducción: Las manifestaciones clásicas de vasculitis por inmunoglobulina A (IgA) son púrpura palpable sin trombocitopenia, artritis, dolor abdominal y lesión renal; sin embargo, alrededor de 10% de pacientes pueden presentar manifestaciones testiculares. Caso clínico: Se describe el caso de paciente masculino de cuatro años de edad que acude a urgencias por dolor en escroto, dolor a la palpación de testículo izquierdo, ausencia de reflejo cremasteriano, eritema y tumefacción en ambos escrotos. Se realiza ultrasonido testicular evidenciando vasculatura intratesticular y peritesticular bilateral con datos de proceso inflamatorio agudo. Ante la presencia inicial de púrpura palpable y dolor abdominal difuso se integró diagnóstico de vasculitis por IgA con manifestaciones escrotales. Se decidió iniciar tratamiento con esteroide sistémico (prednisolona 1 mg/kg/día), con resolución del cuadro en 48 horas. Conclusiones: En la literatura se reportan casos de manifestaciones escrotales asociados al diagnóstico de vasculitis por IgA, por lo general de forma unilateral tratados habitualmente con esteroide, no existen datos publicados sobre el pronóstico a largo plazo de los pacientes que cursaron con esta manifestación.

Abstract: Introduction: The classic clinical manifestations of inmunoglobulin A (IgA) vasculitis are palpable purpura without thrombocytopenia, arthritis, abdominal pain, and kidney injury, however, around 10% of patients may present scrotal manifestations. Case report: We report the case of a 4-year-old male patient who presented to the emergency room for pain in the scrotum, five days previously with the presence of dermal lesions in both lower extremities and mild abdominal pain, on physical examination found pain on palpation of the left testicle, absence of ipsilateral cremasteric reflex, erythema and swelling in both scrotums, testicular ultrasound was performed showing bilateral intratesticular and peritesticular vasculature with data of an acute scrotal inflammatory process. Given the clinically palpable purpura and abdominal pain, a diagnosis of IgA vasculitis with scrotal manifestations was integrated, according to what is referred to in the literature, it was decided to start treatment with a systemic steroid (methylprednisol 1 mg/kg/day), with the resolution of the condition in 48 hours. Conclusions: In the literature, cases of scrotal manifestations associated with the diagnosis of IgA vasculitis are reported, generally unilaterally treated habitually with steroids, there are no published data on the long-term prognosis of patients who presented with this manifestation.