Reconstruction of perineo-scrotal defects from Fournier’s gangrene with the adipofascial anterolateral thigh flap

Abstract

To present a small case series of a novel solution, using pedicled adipofascial anterolateral thigh (ALT) flaps for skin grafting, for the reconstruction of perineo-scrotal defects following Fournier's gangrene (a complex surgical problem). Many options are described. We believe that this procedure overcomes the contracture complications of skin grafting alone and that it is a more supple reconstruction in the Western population. Patients: We performed pedicled adipofascial ALT flaps on three patients, for the reconstruction of complex perineoscrotal wounds with exposed testes, following Fournier's gangrene. Patients were of male gender, aged 38 -56 years old and otherwise healthy. The adipofascial ALT flap was raised based on the lateral circumflex femoral artery and was inset with split-thickness skin graft coverage. Results: Study outcomes were time-to-healing and complications. Follow-up was between 6 months to 4 years. At routine outpatient follow-up, all three patients had healed wounds; and at long-term follow-up, all three patients were satisfied with their wound reconstruction. There were no surgical complications. Conclusion:This study demonstrated that the pedicled adipofascial ALT flap is a reliable flap that is straightforward to raise, of an appropriate bulk, and has pliability for the neo-scrotum. The authors recommend this procedure as a good treatment option for reconstructing complex perineo-scrotal wounds following Fournier's gangrene.

Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report

“…Novel risk factors have been reported in the literature, including sodium-glucose cotransporter-2 (SGLT2) inhibitors and immunosuppression [16][17][18][19][20][21][22][23]. SGLT2 inhibitors are a recent introduction to oral hypoglycemic agents.…”

“…Surgical scrotal reconstruction techniques post-FG also feature predominantly in the literature [19,[21][22][23][24][25][26]. The loss of skin and the subsequent layers of perineal tissue following necrotizing infection poses a reconstructive challenge.…”