Korean J Urogenit Tract Infect Inflamm.  2013 Oct;8(2):114-120. 10.14777/kjutii.2013.8.2.114.

Scrotal Reconstruction with Pedicled Anterolateral Thigh Perforator Flap in Fournier's Gangrene

• Oh HC
• Bae SH
• Lee JW
• Kim JH
• Nam SB

• KMID: 1502117
• DOI: http://doi.org/10.14777/kjutii.2013.8.2.114

Abstract

PURPOSE
We have many choices of surgical methods with scrotal reconstruction after Fournier's gangrene. From the aesthetic perspective, the reconstruction method with anterolateral thigh perforator pedicled flap is better than other options. We report our experience with postoperative results and aesthetics of the anterolateral thigh perforator pedicled flap.
MATERIALS AND METHODS
From November 2011 to May 2013, 4 patients underwent anterolateral thigh perforator pedicled flaps. The authors checked the aesthetic results and occurrence of complications at follow-up exams.
RESULTS
There was no total or partial necrosis of flap among the four patients. The only complication was wound dehiscence followed by infection that healed secondarily during the follow-up period.
CONCLUSIONS
Anterolateral thigh perforator pedicled flap is a very useful choice for surgery at the defect caused by Fournier's gangrene because it is relatively thin, offering an excellent aesthetic result.

Keyword

Fournier gangrene; Surgical flaps

MeSH Terms

Esthetics
Follow-Up Studies
Fournier Gangrene*
Humans
Methods
Necrosis
Perforator Flap*
Surgical Flaps
Thigh*
Wounds and Injuries

Figure

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  Fig. 1. Preoperative and postoperative one-month views after scrotal reconstruction by anterolateral thigh perforator (ALTp) flap that had two perforators. We archived satisfactory result from enough inferior sagging of reconstructed scrotum that was obtained with mildly rotation of ALTp flap and usage of remnant scrotal skin on left side.

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  Fig. 2. Preoperative and postoperative 8-month views with anterolateral thigh perforator. The result shows natural scrotal shape without any contracture or deformity.

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  Fig. 3. Preoperative and postoperative 5-month views with anterolateral thigh perforator flap. Dog ear deformity was presented on anterior center of reconstructed scrotum, but the better shape of scrotum can be encouraged by simple excision under local anesthesia if the patient was wanted.

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  Fig. 4. Preoperative and postoperative 4-month views with anterolateral thigh perforator flap.

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  Fig. 5. The distal marginal necrosis of the random flap that has a kine of medial thigh flap occurred often because of folding of it when was used for reconstruction of scrotal area. It was also poor aesthetic result.

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  Fig. 6. The small sized flap can not be taken the good aesthetical result because it is the two-dimensional reconstruction that was too tight and less bagged.

Reference

1. Ferreira PC, Reis JC, Amarante JM, Silva AC, Pinho CJ, Oliveira IC, et al. Fournier's gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg. 2007; 119:175–84.

2. Datubo-Brown DD. Alternative techniques for scrotal reconstruction. Br J Urol. 1990; 65:115–7.

3. McAninch JW. Management of genital skin loss. Urol Clin North Am. 1989; 16:387–97.

4. Tiwari IN, Seth HP, Mehdiratta KS. Reconstruction of the scrotum by thigh flaps. Plast Reconstr Surg. 1980; 66:605–7.

5. Westfall CT, Keller HB. Scrotal reconstruction utilizing bilateral gracilis myocutaneous flaps. Plast Reconstr Surg. 1981; 68:945–7.

6. Lee SR, Kang NH, Oh SH. Resurfacing the large penoscrotal defects with various local flaps after ablation of extramammary Paget's disease. J Korean Soc Plast Reconstr Surg. 2007; 34:753–8.

7. Kim BJ, Heo CY. Scrotal reconstruction with pedicled anterolateral thigh perforator flap. J Korean Soc Plast Reconstr Surg. 2009; 36:348–50.

8. Yu P, Sanger JR, Matloub HS, Gosain A, Larson D. Anterolateral thigh fasciocutaneous island flaps in perineoscrotal reconstruction. Plast Reconstr Surg. 2002; 109:610–6.

9. Hallock GG. Scrotal reconstruction following Fournier's gangrene using the medial thigh fasciocutaneous flap. Ann Plast Surg. 1990; 24:86–90.

10. Kim KS, Noh BK, Kim DY, Lee SY, Cho BH. Thin paraumbilical perforator-based cutaneous island flap for scrotal resurfacing. Plast Reconstr Surg. 2001; 108:447–51.

11. Spyriounis PK. The extended approach to the vascular pedicle of the anterolateral thigh perforator flap: anatomical and clinical study. Plast Reconstr Surg. 2006; 117:997–1001.

12. Lannon DA, Ross GL, Addison PD, Novak CB, Lipa JE, Neligan PC. Versatility of the proximally pedicled anterolateral thigh flap and its use in complex abdominal and pelvic reconstruction. Plast Reconstr Surg. 2011; 127:677–88.