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

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.

A Rare Case of Idiophatic Fournier’s Gangrene: Scrotal Reconstruction via Anterolateral Thigh Flap

Fournier’s gangrene (FG) is a surgical emergency. The main treatment plan for this disease includes several aggressive debridements, which lead to the development of massive soft-tissue defects in the affected area. Current literature describes various possible reconstructive options for the closure of those defects, yet, there is no evidence on which is the most efficient. Here we describe an unusual case of an otherwise healthy male presenting with a scrotal Fournier’s gangrene. In our case, the reconstruction was performed via anterolateral thigh flap. Due to a postoperative complication the flap was partly lost, however, consequences were managed successfully and a satisfactory result was achieved.

Extended medial sural artery perforator free flap for groin and scrotal reconstruction

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearmbased flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

Fournier's Gangrene: From Diagnosis to Reconstruction

Fournier gangrene (FG) is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long-term alcohol misuse; however, it can also affect patients with non‐obvious immune compromise. Twenty patients were admitted to our hospital with the diagnosis of Fournier gangrene, between 1 January 2011 to January 2013. The epidemiological characteristics, evolution and treatment modalities were reviewed. Early surgical debridement of necrotic tissues and antibiotics are fundamental in the treatment of FG. Scrotal reconstruction with skin grafts or flaps is fundamental to improve the quality of life and provides social reinsertion.