Scrotal reconstruction using a superficial circumflex iliac artery perforator flap following Fournier's gangrene

Abstract

Fournier's gangrene is a type of necrotising fasciitis around the scrotum and perineum. Because of its aggressive nature, patients should be treated with broad-spectrum antibiotics and emergency, radical debridement during the acute phase. After recovering from the acute phase, reconstruction of the scrotal and perineal soft tissue defects is needed and is often challenging. Traditionally, various reconstruction methods have been used, including skin grafts, fasciocutaneous flaps and musculocutaneous flaps, each with its pros and cons. We successfully covered a wide scrotal defect using a superficial circumflex iliac artery perforator flap, which has not been previously reported for this indication. The design and operative technique are introduced in this study.

Keywords: Fournier's gangrene; SCIP; Scrotal defect.

Figure 1

A scrotal defect, approximately 144 cm² (12 × 12 cm), and a thigh soft tissue defect, about 360 cm² (30 × 12 cm), were noted.

Figure 2

The presence of a perforator (arrow) from the superficial circumflex iliac artery (SCIA) is confirmed by multidetector‐row computed tomography. A star indicates the sartorius muscle.

Figure 3

Considering the distance between the perforator (pivot point of flap) and the defect, a 24 × 12‐cm elliptical flap was designed in the right flank.

Figure 4

Elevation of flap. The perforator of superficial circumflex iliac artery perforator (SCIP) flap is indicated by the forcep.

Figure 5

An immediate postoperative photography after insetting. Scrotal defect was covered without bulkiness in the inguinal area.

Figure 6

Eighteen‐month postoperative photography.

Figure 7

A 49‐year‐old male patient was referred for reconstruction of a scrotal defect caused by Fournier's gangrene. The defect size was 105 cm² (15 × 7 cm).

Figure 8

Sixteen‐month postoperative photography.