Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene

Abstract

Rationale:Necrotizing fasciitis (NF), characterized by widespread fascial necrosis, is a rare disease in clinic. Fournier gangrene (FG) is a special type of NF involved of perineum and scrotum. To our knowledge, no article has reported on bilateral femoral posterior neurocutaneous perforater flap treating for FG.Patient concerns:A 61-year-old Chinese male complained of perineal skin necrosis for 19 days. The patient received treatment in other hospital due to chronic bronchitis on April 15th and body temperature ranged from 38 to 39 °C. Then he received antiinfection therapy. Perianal cutaneous occurred mild necrosis on May 08th. And the necrosis generally deteriorated. He came to our hospital for treating necrosis in area of perineum and scrotum on May 28th.Diagnoses:He was diagnosed with FG and chronic bronchitis.Interventions:The patient underwent debridement on June 2nd and received bilateral femoral posterior neurocutaneous perforater flap on June 29th. Besides, the patient was treated with whole-body nutrition support and antibiotic treatment.Outcomes:One week after the 2nd operation, the flap showed normal color. The result shows good outcome and no recurrence of the clinical symptoms occur till now.Lessons:FG is rare. Bilateral femoral posterior neurocutaneous perforater flap is an effective procedure to treat FG. The outcome of combined therapy is satisfactory.

Management of Fournier’s Gangrene in a Low Resource Setting

“…Other forms of wound closure including flaps were also reported in that review [30] which wasn't performed in our center due to lack of expertise by the urology team and lack of plastic surgeon. Wang et al [31] described the use of vacuum sealing device and femoral posterior neurocutaneous perforator flaps preserving the blood supply and sensation in the treatment of perineal gangrene, none was used in our study.…”

Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction

“…Furthermore, it allows for the formation of a scrotal septum [60], which can prevent testicular torsion. The choice between using a unilateral flap or bilateral flaps for reconstruction depends on various factors, including the size and location of the defect [61,62], the patient's anatomy and health status, and the specific goals of the reconstruction. For large defects, bilateral flaps may provide more tissue for coverage and thus be more suitable.…”

“…The relative thickness compared to SCIP flaps may compromise the preservation of spermatogenic function. [33,61,67] [ 33,58,59,62,[68][69][70][74][75][76][77] These flaps can be used on a unilateral side or elevated from bilateral sides. BMI, body mass index; SCIP, superficial circumflex iliac perforator; ALT, anterolateral thigh.…”