scholarly journals Scrotal reconstruction with pedicled gracilis muscle flap following Fournier’s gangrene: a case report and literature review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Oluwatosin Stephen Ilori ◽  
David. A. Onilede ◽  
Ademola. A. Popoola ◽  
Olorunnisola O. Olatide ◽  
Chidi O. Ugwuoke
Keyword(s):  
Donor Site ◽  
Outlet Obstruction ◽  
Muscle Flap ◽  
External Genitalia ◽  
Donor Site Morbidity ◽  
Fournier’S Gangrene ◽  
Gracilis Muscle ◽  
Fournier's Gangrene ◽  
Additional Advantage ◽  
Gracilis Muscle Flap

Abstract Background Fournier’s gangrene is an acute soft tissue necrotizing infection involving the perineum and the external genitalia which can result in a major loss of the scrotal wall with exposure of the testicles. Reconstruction of such major defect is quite challenging; the use of pedicled gracilis muscle flap helps to create an aesthetically acceptable scrotum with minimal donor site morbidity. Case presentation We described the case of a 60-year-old man with a large scrotal loss from Fournier’s gangrene following bladder outlet obstruction and perineal abscess. He had multiple debridement and reconstruction with pedicled left gracilis muscle flap with a good aesthetic and functional post-operative outcome. The major challenge encountered was the loss of the skin graft as a result of the retraction of the muscle flap due to too early ambulation; this can thus be avoided by adequate pre-operative counseling and enforcing bed rest. Conclusions The use of gracilis muscle flap in the reconstruction of large scrotal defect described in this report has the additional advantage of creating a pliable and soft feel like that of the original scrotum with minimal donor site morbidity.

Donor-Site Morbidity of Free Muscle and Perforator Flaps: Comparison of the Gracilis Muscle Flap and the Anterolateral Thigh Flap

2017 ◽  
Vol 33 (07) ◽  
pp. 526-532 ◽  
Author(s):  
M. Rassner ◽  
J. Kiefer ◽  
H. Bannasch ◽  
G. Stark ◽  
S. Eisenhardt ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Donor Site ◽  
Muscle Flap ◽  
Donor Site Morbidity ◽  
Gracilis Muscle ◽  
Perforator Flaps ◽  
Muscle Flaps ◽  
Gracilis Muscle Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Background Both the gracilis muscle flap and the anterolateral thigh (ALT) flap have been described as successful reconstructive options for defect coverage after trauma or tumor resection. In general, free perforator flaps are considered to generate less donor-site morbidity than muscle flaps. Here, we put this hypothesis to the test. Methods In this study, 193 patients who had undergone free flap reconstruction with either free gracilis muscle flaps (n = 131) or ALT flaps (n = 62) were included. Subjective patient satisfaction with the aesthetic and functional outcome of the donor sites was assessed using a self-report questionnaire as well as the Lower Extremity Functional Scale (LEFS). Results Comparing the donor-site morbidity of free ALT and gracilis flaps, the LEFS revealed no significant differences in functional impairment (p = 0.6447) of the lower extremity. The donor-site scar was significantly longer after ALT flap harvest (mean: 21.16 cm) than after gracilis muscle flap harvest (mean: 14.17 cm; p < 0.0001). Furthermore, donor-site numbness was significantly greater in the ALT group than in the gracilis group (p = 0.0068). Conclusion No significant differences in functional impairment of the lower extremity were reported after gracilis muscle and ALT flap harvest. Regarding scar length and level of numbness of the donor site, the gracilis muscle flap was shown to be superior to the ALT flap.

Total scrotal reconstruction following Fournier’s gangrene with bilateral prelaminated superior medial thigh flaps

2021 ◽  
Vol 14 (4) ◽  
pp. e240618
Author(s):  
Justin Hart ◽  
Jeffrey DeSano ◽  
Raymond Hajjar ◽  
Christopher Lumley
Keyword(s):  
Muscle Flap ◽  
Skin Grafting ◽  
Fournier’S Gangrene ◽  
Ischiorectal Fossa ◽  
Fournier's Gangrene ◽  
Dermal Matrix ◽  
Gracilis Muscle Flap ◽  
Medial Thigh ◽  
Split Thickness Skin Grafting ◽  
Scrotal Reconstruction

The patient is a 45-year-old man diagnosed with Fournier’s gangrene and underwent treatment for septic shock, broad-spectrum antibiotic therapy and extensive surgical debridement of perineum, including total scrotectomy, ischiorectal fossa, abdomen and left superior thigh and flank. The patient required multiple staged complex reconstruction of the scrotum utilising prelaminated superior medial thigh flaps with use of dermal matrix, split-thickness skin grafting and pedicled gracilis muscle flap for coverage of the ischiorectal wound. The patient had full recovery and followed up 1 year postoperatively. This report discusses our technique for total scrotal reconstruction and provides review of surgical reconstructive techniques for wounds due to Fournier’s gangrene.

Fournier’s gangrene due to Salmonella Typhimurium in a healthy male: a rare aberrant infection

2020 ◽  
Vol 20 ◽  
Author(s):  
Varsha Gupta ◽  
Lipika Singhal ◽  
Kritika Pal ◽  
Mani Bhushan ◽  
Rajeev Sharma ◽  
...  
Keyword(s):  
Salmonella Typhimurium ◽  
Systemic Disease ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
The Body ◽  
Healthy Male ◽  
Fournier's Gangrene ◽  
Salmonella Infections ◽  
Chief Complaints ◽  
Human Infections

Introduction: Human Salmonella infections have been classically distinguised into diseases caused by typhoidal and non-typhoidal salmonella (NTS). Typhiodal salmonella includes S. enterica serovars Typhi and Paratyphi that cause the systemic disease but are restricted to human infections, while NTS consists mainly of other serovars that predominantly cause self-limiting gastroenteritis in humans. Localisation of foci with persisting infection occurs due to dissemination of the bacteria throughout the body and can cause a variety of rare clinical syndromes at aberrant sites. Fournier’s gangrene, a rapidly progressive, often fatal, necrotizing fasciitis of the external genitalia and perineum due to Salmonella Typhimurium, is a rare manifestation and has never been reported. Case: A 22-year-old male, apparently healthy patient with no relevant past medical history presented to surgical emergency with chief complaints of swelling of bilateral scrotal area. Infective etiology was considered and a diagnosis of fournier’s gangrene was made. Pure growth of Salmonella Typhimurium was obtained after repeated subculture and was identified biochemically and on serotyping, as Salmonella enterica serotype Typhimurium using specific antisera. Conclusion: In our case report, we describe a case of fournier’s gangrene due to Salmonella Typhimurium in an otherwise healthy male to highlight the unusual presentation of Non typhoidal salmonellae at an aberrant site. We also emphasize the importance of using selective media like Selenite F broth for isolation of Salmonella Typhimurium from a pus sample.

scholarly journals Management of peno-scrotal wound defects in a tertiary hospital in North-Western Nigeria: a 20-year retrospective review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abubakar Sadiq Muhammad ◽  
Ngwobia Peter Agwu ◽  
Abdullahi Abduwahab-Ahmed ◽  
Ahmed Mohammed Umar ◽  
Muhammad Ujudud Musa ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Graft Loss ◽  
External Genitalia ◽  
Tertiary Hospital ◽  
Advancement Flap ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Direct Closure ◽  
Secondary Intention ◽  
North Western

Abstract Background Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria. Methods This is a 20-year retrospective study of patients managed for peno-scrotal wound defects by the Urology Unit in the Department of Surgery of our hospital from January 2001 to December 2019. Data were collected from the patients’ case notes and entered into a proforma. Data were analysed using SPSS version 25.0. Results A total number of 54 patients with peno-scrotal wound defects were managed within the study period with the mean age of 46.27 ± 22.09 years and a range of six weeks to 107 years. The wound defects were sequelae of Fournier’s gangrene in 42 patients (77.8%) and traumatic in 12 patients (22.2%). Healing by secondary intention was achieved in 20 patients (37.0%). Direct closure was done in 17 patients (31.5%), skin graft in nine patients (16.7%), and advancement flap in eight patients (14.8%) depending on the location and size of the defects. Fourteen patients (26.0%) developed surgical site infection ± wound dehiscence and partial graft loss. The complication rate was higher in post-Fournier’s gangrene wound defects, but without statistical significance (p = 0.018). Conclusion Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. Smaller wound defects were healed by secondary intention, while larger defects required either direct closure or the use of advancement flap or skin grafting depending on the location and size of the wound. The study reported a higher post-repair complication in patients that had Fournier’s gangrene.

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