Superiority of Medial Circumflex Femoral Artery Perforator Flap in Scrotal Reconstruction

Abstract

Scrotal skin has unique cosmetic and functional features that make its reconstruction difficult. Coverage of the testicles and constituting a good cosmetic appearance are major expectations from a successful reconstruction. Usually flaps are the choice for scrotal reconstruction, but every single flap has its own characteristics. In our series, between January 2006 and January 2010, the medial circumflex femoral artery perforator flap was used in 7 male patients for scrotal coverage after Fournier gangrene. Six flaps were raised based on a single perforator from the gracilis muscle; however in one flap 2 perforators were used. Flaps were carried to the defect either by transposition or by V-Y advancement. Donor areas were closed directly in all patients, and stable scrotal coverage was achieved with an acceptable scrotal contour and cosmesis. No major complication was seen due the perforator flap surgery, in 2 patients wound dehiscence were noted and they healed by secondary intention or by secondary suturing. For scrotal reconstruction, the medial circumflex femoral artery perforator flap is a good option with its good mobility, thinness for scrotal contour, possibility for muscle preservation, and direct closure of the donor site. All these advantages can be accomplished in 1 procedure.

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.…”

“…Previously, traditional musculocutaneous flaps from the medial thigh were widely used; however, these flaps are currently considered too bulky (KayikçioğLu, ; Young & Wright, ). The fasciocutaneous flap, or the concept of the perforator flap, was recently modified to allow reconstruction using thinner tissue (Ahn, Kim, Park, & Kim, ; Coskunfirat, Uslu, Cinpolat, & Bektas, ; Han et al, ; Lee et al, ; Wang et al, ; Yang, Ko, Oh, & Jung, ). Various flaps from the thigh (Lee et al, ; Yang et al, ) or the inferior gluteal area (Han et al, ), such as the anterolateral thigh flap (Wang et al, ), medial circumflex femoral artery perforator flap (Coskunfirat et al, ), and the internal pudendal artery perforator flap (Ahn et al, ) have been used.…”

Pedicled Anterolateral Thigh Flap as a Cover for Reconstruction of Post Fournier’s Gangrene Scrotal Defects

“…Testicular coverage is often prioritized over scrotal cosmesis due to the comorbidities typically seen in this patient population. 1-3 Several techniques have been described to provide durable coverage, but do not necessarily provide an ideal cosmetic result [4][5][6][7][8][9][10][11][12][13][14][15] such as split thickness grafts, muscle flap (ex: gracilis muscle) and fasciocutaneous flaps, (ex: pudendal), perineal flap, deep inferior epigastric perforator flap, anteromedial thigh flap and anterolateral thigh flap. In this study, we present our experience with the use of pedicled anterolateral thigh (ALT) flap to cover scrotal defect caused by Fournier's gangrene.…”

Common origin of the medial circumflex femoral and inferior epigastric arteries from the femoral artery

“…Importance of variation of these arteries for reconstruction of perine, scrotum, head (especially maxilla) and neck is cited in literature (2,3,4,5).…”