Using the Pedicle Anterolateral Thigh Flap as an Optional Method in Fournier's Gangrene Wound Reconstruction

Abstract

Fournier's gangrene is the progressive necrotizing infection of the perineum and genital fascia with gangrene of the overlying skin. The effective treatment includes aggressive debridements, broad-spectrum antibiotics, and intensive supportive care. Radical debridements often result in spermatic cord and testis exposure and need secondary reconstruction after infection controlled. How to achieve a cosmetic and functional reconstruction is a challenge. We provide our experience in scrotum reconstruction using the pedicled anterolateral thigh flap. From October 2005 to August 2006, there were seven patients who received pedicled anterolateral thigh fasciocutaneous flaps transfer for the complex perineal defects at the China Medical University Hospital. There were six male patients and one female patient, aged from 45 to 70 years old. The seven patients received one to three times wound debridements and were finally resurfaced with a pedicle anterolateral thigh fasciocutaneous flap transfer, to cover the scrotum, perianal, or lower abdominal skin defect. No cutaneous flap suffered from partial necrosis after transfer. There are two patients who received the split skin graft simultaneously with flap transfer for bigger abdominal defect. The size of the flaps ranged from 50 to 180 centimeter square and was supplied by single perforator. Post-operation wound healing and outlook is very good. Pedicle anterolateral thigh fasciocutaneous flap is a good surgical option in Fournier's gangrene reconstruction. The skin paddle can be adjusted geographically to match the critical defect and the pedicle length can be easily lengthened by ”pedicle extension technique”. The outlooks of the results are natural and less post-op morbidity were noted in our series.