Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report

Abstract

Fournier's gangrene can lead to extensive defects of the perineoscrotal area with exposure of the testes. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Due to its proximity, medial thigh skin appeared to be the most versatile donor site for perineoscrotal reconstruction. In this report, we present a case of reconstruction of a large perineoscrotal defect because of Fournier's gangrene using a posteromedial thigh (PMT) perforator propeller flap. A 58 year-old male who suffered from Fournier's gangrene resulted in a scrotal defect of 10 × 12 cm(2) with a large dead space. A pedicled PMT propeller flap measuring 9 × 23 cm(2) with two perforators that originated from the profunda femoris artery (PFA) was harvested for scrotal defect reconstruction and dead space obliteration. The flap survived completely, with no recipient or donor site morbidity. The length of followup was 3 months and was uneventful. The pedicled PMT propeller flap may be considered as a valid option for perineoscrotal reconstruction.

The vertical posteromedial thigh (vPMT) flap for autologous breast reconstruction: A novel flap design

“…The posteromedial thigh (PMT) flap has been regarded as a reliable option for reconstruction of a variety of defects throughout the body. Our group has applied the PMT flap in the transverse and vertical fashion for head and neck, trunk and lower extremity defects reconstruction …”

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

“…With medial thigh skin as donor site, it has been recognized as ideal because of its vicinity . The PMT flap based on the first perforator of the profunda femoris artery has been reported to be an option for per perineoscrotal reconstruction: it offers abundant skin coverage and the propeller fashion approach can be used both for scrotal and perineal reconstruction . However, both of them are based on perforators arising from the profunda femoris of the upper medial thigh and in our case they were not more available because of the extent of the fasciitis and subsequent debridement.…”

“…The goals of perineoscrotal reconstruction are restoration of form and function, with reasonable cosmesis. Many reconstructive options have been employed: from simple skin graft to more complex reconstructions with fasciocutaneous and musculocutaneous flaps, and the recently popularized perforator flaps . Because of the extent of necrosis of this particular patient, a massive defect was found involving the scrotum, perineum, and upper medial thigh area after serial debridement; moreover, the femoral vessels were extensively exposed.…”

“…Hence, pedicle perforator flaps from the medial thigh such as the medial circumflex femoral artery perforator (MCFAP) flap and the posteromedial thigh (PMT) perforator flap were not a plausible therapeutic option anymore . The MCFAP flap has become popular for perineoscrotal reconstruction in the past few years.…”

Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap

“…The medial circumflex femoral artery flap (Coskunfirat et al, ; Hallock, ; Karsidag, Akcal, Sirvan, Guney, & Ugurlu, ), profunda femoris artery perforator flap (Scaglioni, Chen, & Yang, ), and combined multiple perforator flaps (Hong et al, ) have also been used for the reconstruction of the perineal area. Although the perforator location is closer than the lateral thigh flap, it is difficult for inexperienced surgeons to perform as there are numerous variations in the perforator location.…”