Reconstruction of perineoscrotal defects in Fournier's gangrene with pedicle anterolateral thigh perforator flap

Abstract

Early debridement and wound coverage in Fournier's gangrene are mandatory to allow patients to return to normal life. Pedicle ALT perforator flaps provide pliable and reliable soft-tissue coverage for large perineoscrotal defects with adequate contour that result in satisfactory function and cosmesis.

Clinical applications of the pedicled anterolateral thigh flap in reconstruction

“…25,26 We used the pedicled ALT flap in 10 patients who sustained a large skin defect of the scrotum (mean area, 122.5 cm 2 ; range, 72-198 cm 2 ). 8 In our series, all defects were reconstructed by pedicled ALT flaps offering the benefits of free tissue transfer without the complexity of microsurgery. The flap provides versatility in its components as it can be raised as a fasciocutaneous flap, a myocutaneous flap, a fasciocutaneous flap combined with the TFL, or just as a plain muscle flap depending on the tissue component need in the defect.…”

“…Fasciocutaneous thigh flaps that do not need to sacrifice a functioning muscle are less bulky and have been used to cover perineoscrotal defects, such as pudendal thigh and medial circumflex femoral artery perforator flaps . We used the pedicled ALT flap in 10 patients who sustained a large skin defect of the scrotum (mean area, 122.5 cm 2 ; range, 72–198 cm 2 ) …”

“…2,3 Although not used extensively, it has also been used successfully as a proximally or distally pedicled flap for reconstruction of defects to the groin, lateral and medial thigh, perineum, gluteal region, abdominal wall and knee. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Reconstruction options for defects of the lower abdomen, groin, trochanter and knee includes myocutaneous pedicled flaps, such as those from the sartorius, gracilis, rectus abdominis and rectus femoris muscles, the tensor fascia latae (TFL), ALT flaps and local skin flaps or free flaps. 9,10 Because of its long vascular pedicle, wide arc of reach, reliable skin territory, variety of tissue components and proximity to these sorts of defects, we prefer a pedicled ALT for reconstruction of these soft-tissue defects.…”

“…Three cases of abdominal wall and one groin defect were also covered using pedicled ALT flaps and one case of a prosthesis‐exposed knee with infection was successfully reconstructed using a reversed ALT flap. We also used the pedicled ALT flap in 10 cases of penoscrotal defects because of Fournier's gangrene . In this series, we present our experience with the use of pedicled ALT perforator flaps to cover the defects from knee to abdomen.…”

“…We also used the pedicled ALT flap in 10 cases of penoscrotal defects because of Fournier's gangrene. 8 In this series, we present our experience with the use of pedicled ALT perforator flaps to cover the defects from knee to abdomen.…”