Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene: A case report

Kadota, Hideki; Momii, Kenta; Hanada, Masuo; Kamizono, Kenichi; Inatomi, Yusuke; Hisanaga, Kana; Yoshida, Shigeaki; Ogaki, Kippei; Kiyoshima, Keijiro

doi:10.1002/micr.30409

Cited by 10 publications

(7 citation statements)

References 13 publications

(19 reference statements)

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“…9 Furthermore, bilateral flap harvesting may be needed for large defects, increasing donor site morbidity and operative time. 11 16 In our specific case, testes' burial and multiple perineal scarring could have jeopardized inner-thigh vascularization and therefore inner thigh flaps were considered not reliable.…”

Section: Discussionmentioning

confidence: 94%

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The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene

Sapino

Gonvers

Cherubino³

et al. 2022

Arch Plast Surg

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When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

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Section: Discussionmentioning

confidence: 94%

“…1 Furthermore, the flap can be meticulously thinned at the level of the superficial fascia, enabling to obtain a thin and pliable flap with minimal adipose tissue layer. 8 In scrotal reconstruction, however, aesthetic results of previous reports 9 10 11 12 are often suboptimal because of the lack of natural ptosis and patchwork appearance.…”

mentioning

confidence: 99%

The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene

Sapino

Gonvers

Cherubino³

et al. 2022

Arch Plast Surg

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“…One of the cases required coverage of a soft tissue defect measuring 36 cm × 18 cm involving the testes, both sides of the groin, the left medial thigh, and perianal skin. This was successfully reconstructed using a left DIEP and bilateral ALT flaps ( 115 ).…”

Section: Resultsmentioning

confidence: 99%

“…Penoscrotal O u r l i t e r a t u r e s e a r c h r e t u r n e d f i v e c a s e s s e r i e s (87,(109)(110)(111)(112) on penile reconstruction, after circumcision complications and penile amputation (109,111), for false hermaphroditism (109) (matching chromosomal and gonadal tissue sex, but mismatching external genitalia) and cases of penoscrotal Paget's disease (87,112). For scrotal reconstruction, five articles were included: there were two case series (47,112), a commentary (113), and two case reports on reconstruction after Fournier's gangrene (114,115). One of the cases required coverage of a soft tissue defect measuring 36 cm × 18 cm involving the testes, both sides of the groin, the left medial thigh, and perianal skin.…”

Section: Penoscrotal and Groin Reconstructionmentioning

confidence: 99%

The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction

Guinier¹,

Clermont-Tonnerre²,

Tay³

et al. 2023

Ann Transl Med

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Background and Objective: The deep inferior epigastric artery perforator (DIEP) flap was first described by Koshima and Soeda in 1989 and is now well-established as the gold standard in breast reconstruction. Lately, this issue has been explored in the context of head and neck reconstruction, highlighting growing interest in the use of the DIEP flap beyond breast reconstruction, but its usage in other anatomical regions appears elusive. Nevertheless, DIEP flap reconstruction may be a viable choice for complex, three-dimensional head and neck deformities while upholding the criteria of minimal donor site morbidity, according to a recent review. To determine whether the DIEP flap may be used successfully in other types of reconstruction, we conducted a review on the use, applications, and outcomes of the DIEP flap in non-breast reconstruction. This is, as far as we are aware, the first comprehensive analysis of all applications of the DIEP flap other than for breast reconstruction.Methods: A literature review was performed using PubMed to include all relevant articles in English or French published up to February 2022. Keywords included "DIEP flap" and "deep inferior epigastric perforator flap". Key Contents and Findings: A total of 1,299 articles were identified with 105 on the use of the DIEP flap in non-breast reconstruction. This suggests increasing recognition of the DIEP flap as a feasible option for reconstruction of most anatomical regions, especially in lower limb and head and neck reconstruction, followed by gynecological reconstruction. The DIEP flap was also utilized in the reconstruction of upper limb, thigh and hip defects. Less commonly, it has been used for penoscrotal, groin, sternal, buttock and abdomen reconstruction. Conclusions:The scientific body of evidence showed the robustness and versatility of the DIEP flap in non-breast reconstruction, with its relative pros and cons at different anatomical regions.

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“…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. Penoscrotal reconstruction using the deep inferior epigastric artery perforator flap, which is one of the most stable flaps with a consistent perforator location, has also has been reported (Kadota et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap

2019

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Background Successful penoscrotal reconstruction requires proper resurfacing of the defect and maintenance of the original shape of the penis and scrotum. We examined the feasibility of using the superficial circumflex iliac artery perforator (SCIP) propeller flap to effectively reconstruct penoscrotal defects. Methods Eleven male patients with an average age of 62.2 years were retrospectively evaluated. The average defect size was 21.3 × 10.5 cm2 (range: 10 × 8–24 × 16 cm2). An eccentrically located elliptical flap was constructed using a handheld Doppler device after detecting the perforator as the pivot point. The medial branch of the superficial circumflex iliac artery was used for all cases. Flaps were designed to cover 70–80% of the defect area and the average rotation arc was 165°. Results The average flap dimension was 19.7 × 7.7 cm2. Two cases showed partial necrosis in the flap tip area. There were no instances of total flap loss or lymphorrhea, or complications such as scar contracture, urination problems, erectile dysfunction, or discomfort during intercourse. Conclusions The SCIP flap is an effective and ideal method for penoscrotal reconstruction considering the loose, elastic, and thin nature of the tissue. Elevation is easily facilitated, and the thickness of the SCIP flap can be adjusted without microsurgery.

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Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene: A case report

Cited by 10 publications

References 13 publications

The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene

The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene

The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction

Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap

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