Skip to main content

Advertisement

SpringerLink
Log in

A surgical challenge: reconstruction of post Fournier’s gangrene large penoscrotal defects with pedicled Gracilis muscle flap

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Large penoscrotal defects with exposed testis are a challenge to reconstruct. Muscle flaps provide an excellent option to reconstruct such defects. The aim of the article is to present the authors’ experience in using gracilis muscle flap in the reconstruction of penoscrotal defects following Fournier’s gangrene.

Methods

All patients with Fournier’s gangrene who underwent a soft tissue reconstruction using unilateral gracilis muscle flap from January 2013 to November 2018 were prospectively included in the study. Patients with exposed testis, penoscrotal defects and dead spaces to fill were included, and exclusion criteria were persistent infection, large defects requiring bilateral gracilis or expected shortfall of coverage using unilateral gracilis muscle. Postop aesthetic assessment was done using modified Vancouver Scar Scale (mVSS) after 6 months by an independent reviewer.

Results

Fourteen cases of post Fournier’s gangrene defects were reconstructed by using gracilis muscle flap with split skin graft in a tertiary care hospital. All were male patients. Age ranged from 20 to 72 years with mean age 35.5 years. After debridement and regular dressings, operation was done under general or spinal anaesthesia. All flaps survived well and there were no major complications encountered. All the patients had acceptable aesthetic outcomes on mean follow-up of 13.2 months.

Conclusions

The pedicled gracilis muscle flap with split skin graft is a good option for large defects involving penis, scrotum and perineum, especially in Fournier gangrene. This flap offers minimal donor site morbidity and minimal major complications with acceptable cosmetic outcomes.

Level of evidence: Level IV, therapeutic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lee SH, Rah DK, Lee WJ (2012) Penoscrotal reconstruction with gracilis muscle flap and internal pudendal artery perforator flap transposition. Urology 79(6):1390–1394

    Article  Google Scholar 

  2. Katusabe LJ, Balumuka D, Hodges A (2013) Scrotal reconstruction with a pedicled gracilis muscle flap after debridement of fournier’s gangrene: a case report. East Afr Med J 90:395–478

    Google Scholar 

  3. Karki D, Patel PK, Narayan RP (2016) Penoscrotal defect: a functional, esthetic and psychological challenge. Plast Aesthet Res 3:64–67

    Article  Google Scholar 

  4. Arafa A (2016) Scrotal and perineal reconstruction by gracilis myocutaneous flap. J Plast Reconstr Surg 40(1):81–87

    Google Scholar 

  5. Kyung H, Kwon H, Song SH, Oh S (2018) Reconstruction using local flaps for penoscrotal defects after ablation of skin lesions. J Wound Manag Res 14(1):37–43

    Article  Google Scholar 

  6. Hejase MJ, Simonin JE, Bihrle R, Coogan CL (1996) Genital Fournier’s gangrene: experience with 38 patients. Urology 47:734

    Article  CAS  Google Scholar 

  7. Corman JM, Moody JA, Aronson WJ (1999) Fournier’s gangrene in a modern surgical setting: improved survival with aggressive management. BJU Int 84:85

    Article  CAS  Google Scholar 

  8. Ferreira PC, Reis JC, Amarante JM et al (2007) Fourniers gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg 119(1):175–184

    Article  CAS  Google Scholar 

  9. Ellabban MG (2004) Single stage muscle flap reconstruction of major scrotal defects. Burns 30:505

    Article  Google Scholar 

  10. Islam MT, Dey PK, Karnal AHM et al (2017) Evaluation of scrotal reconstruction with thigh flap. Bang Med J Khulna 50:13–17

    Article  Google Scholar 

  11. Daigeler A, Behr B, Mikhail B, Lehnhardt M, Wallner C (2016) Bilateral pedicled gracilis flap for scrotal reconstruction. J Plast Reconstr Aesthet Surg 69(9):e195–e196

    Article  Google Scholar 

  12. Can B (2019) Reconstruction after Fournier gangrene: our approaches and outcomes. Turk J Plast Surg 27:132–136

    Google Scholar 

  13. Tran N (2011) Scrotal and perineal reconstruction. Semin Plast Surg 25(03):213–220

    Article  Google Scholar 

  14. KayikçioğLu A (2003) A new technique in scrotal reconstruction: short gracilis flap. Urology 61(6):1254–1256

    Article  Google Scholar 

  15. Hsu H, Lin CM, Cheng LF, Chien SH (2007) Unilateral gracilis myofasciocutaneous advancement flap for single stage reconstruction of scrotal and perineal defects. JPRAS 60(9):1055–1059

    PubMed  Google Scholar 

  16. Kim KS, Noh BK, Kim DY et al (2001) Thin paraumbilical perforator-based cutaneous island flap for scrotal resurfacing. Plast Reconstr Surg 108(2):447–451

    Article  CAS  Google Scholar 

  17. Hallock GG (1990) Scrotal reconstruction following Fournier’s gangrene using the medial thigh fasciocutaneous flap. Ann Plast Surg 24:86–90

    Article  CAS  Google Scholar 

  18. Koshima I, Soeda S, Yamasaki M, Kyou J (1988) The free and pedicled anteromedial thigh flap. Ann Plast Surg 21:480

    Article  CAS  Google Scholar 

  19. Hirshowitz B, Peretz BA (1982) Bilateral superomedial thigh flaps for primary reconstruction of scrotum and vulva. Ann Plast Surg 8:390–396

    Article  CAS  Google Scholar 

  20. Maharaj D, Naraynsingh V, Perry A, Ramdass M (2002) The scrotal reconstruction using the “Singapore sling.” Plast Reconstr Surg 110:203–205

    Article  Google Scholar 

  21. El-Khatib HA (2002) V-Y fasciocutaneous pudendal thigh flap for repair of perineum and genital region after necrotizing fasciitis: modification and new indication. Ann Plast Surg 48(4):370–375

    Article  Google Scholar 

  22. Sharzer LA, McCarthy JG (1990) Free flap transfer in the upper extremity plastic surgery. WB Saunders, New York, p 446

    Google Scholar 

  23. McGregor IA, Soutar D (1990) The groin skin flap. In: Strauch B, Vasconez LO, Hall-Findlay EJ (eds) Grabb’s encylopedia of flaps, vol 2. Little, Brown, Boston, pp 1094–100

    Google Scholar 

  24. Banks DW, O’Brien DP, Amerson JR, Hester TR (1986) Gracilis musculocutaneous flap scrotal reconstruction after Fournier Gangrene. Urology 28:275–276

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic, Burns & Maxillofacial Surgery, V.M. Medical College & Safdarjung Hospital, New Delhi, 110029, India

    Durga Karki, Joyce Jesudas & Vamseedharan Muthukumar

Authors
  1. Durga Karki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joyce Jesudas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vamseedharan Muthukumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DK was the operating surgeon. DK and JJ conceptualised the manuscript. JJ and VM wrote the manuscript and compiled the data and results. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Durga Karki.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Institutional Review Board vide S. No. IEC/VM MC/SJ H/Project/November/2018–1099.

Informed consent

Informed consent was obtained from all individual participants included in the study. The participant has consented to the submission of the data to the journal.

Patient consent

Patients signed informed consent regarding publishing their data and photographs.

Conflict of interests

Durga Karki, Joyce Jesudas, and Vamseedharan Muthukumar declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karki, D., Jesudas, J. & Muthukumar, V. A surgical challenge: reconstruction of post Fournier’s gangrene large penoscrotal defects with pedicled Gracilis muscle flap. Eur J Plast Surg 44, 807–812 (2021). https://doi.org/10.1007/s00238-021-01825-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-021-01825-1

Keywords

Search

Navigation