Penoscrotal reconstruction using groin and bilateral superomedial thigh flaps: a case of penile vaselinoma causing Fournier's gangrene

Abstract

Penile augmentation by the injection of mineral oil provokes many serious, undesirable effects. Although there are reports of complications such as deformity, ulceration, necrosis, and erectile dysfunction, Fournier's gangrene resulting from the injection of petroleum jelly into the penis has not been reported. Here, we present a 42-year-old man with penile vaselinoma causing Fournier's gangrene which was treated successfully with aggressive surgical debridement, followed by penoscrotal reconstruction using groin and bilateral superomedial thigh flaps.

Fig. 1

External genitalia of the patient before penoscrotal reconstruction, showing the penile and scrotal skin defects after extensive debridement of necrotic tissue.

Fig. 2

Anatomic illustration of the left-side groin flap and bilateral superomedial thigh flaps for penoscrotal reconstruction. The feeding vessel for the groin flap is the superficial circumflex iliac artery (SCIA), which arises from the femoral artery. The superomedial thigh flap is a flap with ample blood supply derived from three main sources: the deep external pudendal artery, the medial femoral circumflex artery, and the anterior branch of the obturator artery.

Fig. 3

Intraoperative view immediately after flap application to the penoscrotal defect. The separation of the groin flap was performed 3 weeks after the penoscrotal reconstruction.

Fig. 4

The final postoperative appearance after penoscrotal reconstruction was quite satisfactory. Penile bulkiness and erectile function were also satisfactory.