A Reliable Technique in the Reconstruction of Large Penoscrotal Defect: Internal Pudendal Artery Perforator Flap

Abstract

To reconstruct the defect secondary to Fournier's gangrene, which is an infection localized in the perineum and the lower abdominal region, characterized by large tissue loss following debridement. A large tissue loss caused by Fournier's gangrene brings with repair problems. The primary goal is to achieve cosmetically and functionally successful results. The purpose of this article is to share the results of reconstruction of large penoscrotal defects with internal pudendal artery perforator (IPAP) flap. The data of 13 patients, who were operated with the diagnosis of Fournier's gangrene between October 2014 and September 2018, and whose resulting large scrotal defect repair was carried out with IPAP flap, were evaluated retrospectively. The age of the patients ranged from 32 to 80 years (mean 54.3 years). The smallest flap area was 84 cm2 and the largest flap area was 171 cm2 (mean 120 cm2). The mean follow-up time was 26 months. One patient developed hematoma and 1 patient developed limited necrosis. The remaining defect was repaired primarily in the second surgery. The goal of the repair of the scrotal region is to obtain successful results that will please the patients both cosmetically and functionally. The IPAP flap is close to the defect area and is an easy-to-perform technique. The most important advantages are that it does not require dissection in the muscle tissue, and that successful results can be achieved in the reconstruction of large scrotal defects.