Reconstruction of scrotum with anteromedial thigh flap

Abstract

Background: Reconstruction of extensive defects of the perineum and scrotal region, with exposure of the testes, following avulsion injury or severe infections represents a significant challenge. Replacement with sensate, durable cover is mandatory for functional, cosmetic, and psychological reasons. A wide range of flap techniques has been reported for this purpose with their advantages and disadvantages. We describe the use of the anteromedial thigh flap in our case series with the advantages and disadvantages. Materials and Methods: We had seven patients in our series, of which two patients were posttraumatic defects and other five were post-Fournier’s gangrene unilateral scrotal defects. We describe few case examples in the series in detail, of which the first patient was 21-year-old labor who presented with avulsion injury to penis and scrotum. He had a loss of scrotal skin near totally, except for 2cm × 2cm areas posteroinferiorly. In addition, he also had a loss of penile skin from the glans to the base of the penis. We used bilateral anteromedial thigh fasciocutaneous flap based on the longitudinal axiality of the anteromedial thigh suprafascial plexus for reconstruction. The patient had an excellent recovery, a good aesthetic result at the end of 1 year. Another posttraumatic defect was unilateral and the patient also had a good recovery.The other five patients in series were of Fournier’s gangrene. All patients underwent initially debridement and then flap cover on day 7. All of them needed unilateral scrotal reconstruction. The unilateral anteromedial flap was carried out with good recovery at the end of the 6 weeks. Results: This flap has provided nice durable cover for the testes with an acceptable aesthetic appearance, although the color match was not good in case 3 of the series. Conclusion: In conclusion, anteromedial fasciocutaneous thigh flap is a good choice for scrotal reconstruction that could provide a sensate, durable cover that fulfills patient satisfaction. It is technically easy and has favorable functional and aesthetic results.