Arch Hand Microsurg.  2019 Sep;24(3):254-259. 10.12790/ahm.2019.24.3.254.

Medial Femoral Circumflex Artery Perforator Based Fasciocutaneous Flap Aided in Healing of Scrotal Defect due to Fournier Gangrene

• Hong SW
• Choi HJ
• Kim JH

• KMID: 2456250
• DOI: http://doi.org/10.12790/ahm.2019.24.3.254

Abstract

Fournier's gangrene is a rare, highly infectious necrotizing fasciitis of the perineum and genital area which is caused by a mixture of various bacterial organism. Treatment is predominantly surgical, including extensive and early drainage and debridement, considering negative-pressure wound therapy for helping to heal the wounds and broad-spectrum intravenous antibiotics therapy. Some reports have described the use of negative-pressure wound therapy combined with split thickness skin graft in the defect area. While, other recent reports suggest that local flap coverage rather than skin graft for reconstruction of perineal area. This study aims to suggest the use of medial femoral circumflex artery perforator based thigh flap for scrotal and perineal reconstruction in open areas secondary to the surgical debridement and negative-pressure wound therapy of Fournier's gangrene.

Keyword

Necrotizing fasciitis; Perforator flap; Fournier gangrene; Perineum

MeSH Terms

Anti-Bacterial Agents
Arteries*
Debridement
Drainage
Fasciitis, Necrotizing
Fournier Gangrene*
Negative-Pressure Wound Therapy
Perforator Flap
Perineum
Skin
Thigh
Transplants
Wounds and Injuries
Anti-Bacterial Agents

Figure

• 

  Fig. 1. A 48-year-old male with scrotal and perineal defects due to Fournier's gangrene. (A) Post-opertive periods: 21 days of debridement and negative-pressure wound therapy (B) right unilateral testis totally was exposed.

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  Fig. 2. A 48-year-old male with scrotal and perineal defects due to Fournier's gangrene. Using handheld Doppler, we marked the blue circle meaning the perforator of medial femoral circumflex artery and designed V-Y pattern fascio-cutaneos flap for reconstruction.

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  Fig. 3. Under microscope, the perforator of medical femoral circumflex artery to skin flap which runs deep between the adductor magnus and longus was found and preserved.

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  Fig. 4. Dissected and mobilized flap. Medical femoral circumflex artery perforator preserved V-Y pattern fasciocutaneous flap was elevated without direct muscle handling.

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  Fig. 5. Postoperative images after 12 days. There was no complication within adequate functional and aesthetic results.

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