scholarly journals Early scrotal approximation after hemiscrotectomy in patients with Fournier’s gangrene prevents scrotal reconstruction with skin graft

2013 ◽  
Vol 7 (7-8) ◽  
pp. 481 ◽  
Author(s):  
Oleg Akilov ◽  
Alexandre Pompeo ◽  
David Sehrt ◽  
Paul Bowlin ◽  
Wilson R Molina ◽  
...  
Keyword(s):  
Skin Graft ◽  
Medical Center ◽  
Surgical Care ◽  
Length Of Hospital Stay ◽  
Fournier’S Gangrene ◽  
Tissue Loss ◽  
Split Thickness Skin Graft ◽  
Fournier's Gangrene ◽  
Thickness Skin ◽  
Scrotal Reconstruction

Objective: We report the outcomes of an early loose closure of the scrotum with a modified U-stitch to minimize use of split-thickens skin graft for patients with hemiscrotal tissue loss after surgical debridement.Methods: From January 2006 to August 2011, 28 male patients presented with Fournier’s gangrene, requiring major urological surgical care and scrotal debridement at Denver Health Medical Center. Surgical outcomes were compared between patients receiving a novel U-Stitch approximation and those treated by traditional management.Results: The mean age of the patients was 47.1 ± 10.2 years. In total 8 patients (2.2%) developed bacteremia and 3 (0.1%) had methicillin-resistant staphylococcus aureus (MRSA) infection. There was conversion from the U-Stitch approximation patients to traditional management. U-stitch patients required less hospitalization than patients requiring split-thickness skin graft (STSG) due to loss of >50% of the total scrotal tissue (11 vs. 35 days, p = 0.081). The U-stitch demonstrated non-inferiority to traditional treatment.Conclusion: Immediate loose scrotal wound approximation with efficient surgical debridement for Fournier’s gangrene may prevent testis exposure facilitating local wound treatment, decreasing the length of hospital stay in patients with Fournier’s gangrene involving the scrotum. Future randomized trials may validate these findings.

Split-thickness skin grafting: A modest technique for scrotal reconstruction in patients of Fournier’s gangrene

2019 ◽  
Vol 15 (1) ◽  
pp. 9
Author(s):  
RajeshK Maurya ◽  
Imran Ahmad ◽  
MohammedF Khurram ◽  
Brajesh Pathak ◽  
AliA Mahmud ◽  
...  
Keyword(s):  
Skin Grafting ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Scrotal Reconstruction

Composite Resection Reconstruction: Split-Thickness Skin Graft—A Preferred Option

1988 ◽  
Vol 98 (2) ◽  
pp. 170-173 ◽  
Author(s):  
Larry A. Zieske ◽  
Jonas T. Johnson ◽  
Eugene N. Myers ◽  
Victor L. Schramm ◽  
Robin Wagner
Keyword(s):  
Skin Graft ◽  
Length Of Hospital Stay ◽  
Disease Status ◽  
Split Thickness Skin Graft ◽  
Functional Determinant ◽  
Mandible Reconstruction ◽  
Prosthetic Devices ◽  
Thickness Skin ◽  
Residual Tissue ◽  
Anterior Mandible

In dealing with reconstruction of the oral cavity postcomposite resection, many options are available. Maximization of function with minimization of complications, physiologic sequelae, and cost must be considered. Fifty consecutive patients who underwent composite resections and were reconstructed by split-thickness skin grafts were analyzed. Factors examined included: number of blood units transfused, disease status vs. stage, length of hospital stay, complications, use of prosthetic devices for aiding in swallowing and speech production, and patient diet at discharge. This evaluation and literature review revealed that the amount of tissue resection was considered to be the most significant functional determinant, followed by maintenance of residual tissue mobility. The use of a split-thickness skin graft was believed to give excellent results for the previously mentioned parameters and is our preferred method for reconstruction of composite resection defects that do not require tissue bulk as in anterior mandible defects, anticipated mandible reconstruction, total or near-total glossectomy, or very massive defects.

scholarly journals Free Latissimus Dorsi Flap With Femoral Artery End-to-Side Anastomosis for Perineal Reconstruction Following Fournier’s Gangrene

2020 ◽  
Vol 6 ◽  
pp. 2513826X2096413
Author(s):  
Anna Duncan ◽  
Stephanie Byun ◽  
Justin Paletz
Keyword(s):  
Latissimus Dorsi ◽  
Donor Site ◽  
Skin Grafting ◽  
Fournier’S Gangrene ◽  
Latissimus Dorsi Flap ◽  
Tissue Loss ◽  
Fournier's Gangrene ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Free Latissimus Dorsi Flap

Fournier’s gangrene is a necrotizing infection of the soft tissue structures of the perineum that can extend quickly, requiring aggressive and repeated surgical debridement. This can result in extensive tissue loss and functional impairment, creating reconstructive challenges for plastic surgeons. We present a case of Fournier’s gangrene which resulted in complete loss of the pelvic floor musculature and functional loss of the urinary and fecal outlets. Given the extent of the defect and involvement of areas that would traditionally be used as donor site for local and regional flaps, reconstruction was sought with a free latissimus dorsi flap in combination with split-thickness skin grafting following serial debridement and negative pressure wound therapy. The patient survived and made a satisfactory recovery.

scholarly journals Successful combined approach to a severe fournier’s gangrene

2014 ◽  
Vol 47 (01) ◽  
pp. 132-136 ◽  
Author(s):  
Tommaso Agostini ◽  
Francesco Mori ◽  
Raffaella Perello ◽  
Mario Dini ◽  
Giulia Lo Russo
Keyword(s):  
Surgical Techniques ◽  
Complete Recovery ◽  
Fournier’S Gangrene ◽  
Split Thickness Skin Graft ◽  
Fournier's Gangrene ◽  
Aesthetic Result ◽  
Thickness Skin ◽  
Complex Wound ◽  
Dermal Regeneration Template ◽  
The Right

ABSTRACTWe present a case of a successful reconstruction of a severe Fournier’s gangrene (FG) involving the scrotum, the perineum, the right ischial area and extended to the lower abdomen. There are many different surgical techniques to repair and reconstruct the defect following debridement in FG. The authors treated this complex wound using negative pressure wound therapy (NPWT), dermal regeneration template and a split-thickness skin graft. Complete recovery was achieved and no major complications were observed. The patient showed a satisfying functional and aesthetic result.

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

2020 ◽  
Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello
Keyword(s):  
Comparative Study ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Tactile Sensitivity ◽  
Aesthetic Outcome ◽  
Propeller Flap ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

scholarly journals Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lu ◽  
Ke-Chung Chang ◽  
Che-Ning Chang ◽  
Dun-Hao Chang
Keyword(s):  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Salvage Procedure ◽  
Primary Defect ◽  
Scalp Defects ◽  
Thickness Skin ◽  
Scalp Defect ◽  
Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

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