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. 2018 Jan 15:7:Doc01.
doi: 10.3205/iprs000121. eCollection 2018.

Coverage of the scrotum after Fournier's gangrene

Ahmed Hassan El-Sabbagh  1
Affiliations

Coverage of the scrotum after Fournier's gangrene

Ahmed Hassan El-Sabbagh. GMS Interdiscip Plast Reconstr Surg DGPW. .

Abstract

Background: Fournier's gangrene is a necrotizing fasciitis caused by mixed aerobic and anaerobic bacteria and results in loss of skin and subcutaneous tissue in the perineal area. Coverage of testis varies from closure of the defect primarily, burying inside the thigh, using the remnants of the scrotum for tissue expansion and coverage by flaps. In this manuscript, scrotal advancement flaps and pudendal thigh flaps were used for coverage of the testis unilaterally or bilaterally according to the size of the defect following Fournier gangrene. Patients and methods: From June 2015 to March 2017, twelve cases were admitted to our department. The patients' ages ranged from 37-59 years and they all had suffered from Fournier's gangrene in the perineal area. Results: Of the twelve cases, two cases showed penile involvement. A skin graft was used for coverage of the penile shaft with excellent take. Four cases were closed primarily. This was applied to cases where loss of skin was less than 50%. The rest of the cases were reconstructed by pudendal thigh flap. The reconstructed cases were covered by bilateral pudendal thigh flap (4 cases) and unilateral pudendal thigh flap (4 cases). The follow-up extended up to 16 months. Conclusion: Scrotal advancement flap was suitable for small and medium size defects due to the elasticity of the scrotal skin. Pudendal thigh flap was efficient for the reconstruction of large defects of the scrotum.

Keywords: Fournier's gangrene; pudendal thigh flap; scrotal advancement flap; scrotum.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Table 1
Table 1. Summary of the results
Figure 1
Figure 1. Unilateral pudendal thigh flap. a: Designing the flap. b: Undersurface of the flap. c: Postoperative view.
Figure 2
Figure 2. Partial coverage of both testes treated by scrotal advancement flap. a: Preoperative view. b: Postoperative view (after 1 month).
Figure 3
Figure 3. Complete exposure of the left testis and partial coverage of the right testis treated by unilateral pudendal thigh flap. a: Preoperative view. b: Postoperative view (after 2 months).
Figure 4
Figure 4. Complete exposure of both testes and the shaft of the penis treated by bilateral pudendal thigh flaps and skin graft to the shaft of the penis. a: Preoperative view. b: Postoperative view (after 2 months).
Figure 5
Figure 5. Defect in the perineal area treated by V-Y pudendal thigh flap. a: Preoperative view. b: Postoperative view (after 12 months).
Figure 6
Figure 6. Algorithm for coverage of the scrotum
See this image and copyright information in PMC

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